Morbidity and mortality after surgery [Editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full tex

Surviving Sepsis Campaign Guidelines

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe mortality of severe sepsis is growing due to increased incidense of the syndrome. The speed and appropriateness of therapy administered in the initial hours is likely to influence outcome. Thus, eleven organizations of experts have developed guidelines, evidence based as far as possible, for the bedside management of patients, aimed at improving diagnosis and outcome in sepsis. The guidelines are a part of a campaign named ?surviving sepsis campaign?, see www.survivingsepsis.org The present article is aimed at introducing the guidelines to icelandic doctors.Inngangur Sýklasótt (sepsis), áður nefnd blóðeitrun*, er alvarlegt heilkenni sem orsakast af almennu bólguviðbragði líkamans við alvarlegri sýkingu. Dánartíðni við svæsna sýklasótt (sjá skilgreiningar í töflu I) er á milli 30 og 50%. Þrátt fyrir miklar rannsóknir og aukna vitneskju um sjúkdóminn fer tala dauðsfalla hækkandi vegna vaxandi tíðni sjúkdómsins. Því hafa 11 alþjóðleg samtök lækna hleypt af stokkunum átaki þar sem markmiðið er að bæta greiningu og meðferð við sýklasótt og þannig lækka dánartíðni. Þetta átak nefnist "Surviving Sepsis Campaign" www.survivingsepsis.org sem á íslensku gæti heitið "Sigrumst á sýklasótt". Markmiðið er að minnka dánartíðni af völdum sýklasóttar um 25% á næstu fimm árum. Í þessu augnamiði hafa verið gefnar út allítarlegar leiðbeiningar um meðferð á svæsinni sýklasótt sem byggðar eru eins og kostur er á gagnreyndri læknisfræði (1). Þá hefur verið ráðist í kynningarátak í mörgum löndum, bæði meðal lækna og sumstaðar jafnvel meðal almennings. Sýnt hefur verið fram á að hægt er að minnka dánartíðni af völdum sýklasóttar ef sjúklingar fá skjóta og markvissa meðferð í upphafi sjúkdómsferilsins (2). Þar skiptir meðferðin fyrstu klukkustundirnar sköpum. Þess vegna er mikilvægt að allir læknar séu vel meðvitaðir um snemmbúin einkenni sýklasóttar og fyrstu viðbrögð. Hér á eftir eru nefndar leiðbeiningar kynntar á íslensku og í einu af næstu tölublöðum Læknablaðsins er ætlunin að birta ítarlega yfirlitsgrein um sýklasót

Primary care training during internship - quality and organization

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: In 2000 a new regulation regarding medical licensure came into effect requiring a three-month rotation at a primary health care centre during internship. The aim of this study was to explore the interns' attitude towards this experience, and particularly to find out how well the training was organized, the supervision they received, and the quality of teaching at the health care centres. Methods: In 2002 a survey was mailed to all interns (a total of 65) who had completed training at primary health care centres during 2000 and 2001. Five interns were unreachable and we obtained 38 replies (63% of those reachable, and 58% of target population). Results: The interns received clinical training in providing comprehensive services as well as formal teaching. If an intern needed assistance with patient care he/she was almost always able to obtain help within 10 minutes. In 92% of cases, experienced doctors were available for the interns to consult with during off-duty emergencies. Conclusions: Our results indicate that the current method of teaching interns in the primary health care setting is of good quality, the variety of work experience is positive, and the work environment is satisfactory. Overall the interns expressed satisfaction with their training. A few areas were identified as needing improvement. Further research is needed to assess whether the interns achieve their aims with regard to knowledge, attitude and skills in family practice.Markmið: Árið 2000 tók gildi ný reglugerð þar sem kveðið var á um þriggja mánaða dvöl á heilsugæslustöð sem hluta af starfsnámi unglækna á kandídatsári. Tilgangur þessarar rannsóknar var að kanna viðhorf unglækna til starfsnáms á heilsugæslustöð, einkum hvað varðar skipulag námsins, handleiðslu og kennslugetu stöðvanna. Aðferðir: Árið 2002 var sendur út spurningalisti til allra lækna (alls 65) sem höfðu verið í starfsnámi á heilsugæslustöð á árunum 2000-2001. Ekki náðist í fimm lækna og svör bárust frá 38 af þeim 60 (63%) sem til náðist (58% af markhópnum). Niðurstöður: Unglæknar fengu starfsþjálfun í almennum heilsugæslustörfum auk formlegrar kennslu. Aðgengi eða aðstoð frá leiðbeinandi lækni fékkst í nær öllum tilvikum innan 10 mínútna. Vaktir unglækna um kvöld og helgar voru að jafnaði studdar með bakvakt reynds læknis í 92% tilvika. Ályktanir: Niðurstöður benda til þess að skipulag námsins sé gott, verkefni fjölbreytt, handleiðsla og starfsaðstaða viðunandi og almenn ánægja með námið. Niðurstöður gefa nokkrar vísbendingar um það sem betur má fara. Frekari rannsókna er þörf á því hvort unglæknar nái settum markmiðum varðandi kunnáttu, viðhorf og færni á viðfangsefnum innan heilsugæslunnar

Intensive care patients with influenza A (H1N1) infection in Iceland 2009

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)BACKGROUND: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbrake in 2009. METHODS: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1). RESULTS: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU. CONCLUSIONS: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.Tilgangur: Að lýsa helstu einkennum og afdrifum þeirra sem lögðust inn á gjörgæsludeildir á Íslandi vegna inflúensusýkingar af A stofni (H1N1) haustið 2009. Aðferðir: Aflað var upplýsinga um sjúklinga sem lögðust inn á gjörgæsludeildir á Íslandi með staðfesta H1N1 2009 sýkingu. Niðurstöður: 16 sjúklingar lögðust inn á gjörgæsludeildir vegna inflúensu A (H1N1) sýkingar, meðalaldur 48 ár (1-81). Flestir töldust vera tiltölulega frískir fyrir, en 13 höfðu þó sögu um reykingar, offitu eða háþrýsting. 15 höfðu hita, hósta, öndunarþyngsli og dreifðar íferðir í báðum lungum á lungnamynd og margir fengu fjöllíffærabilun. Allir fengu veirulyf og 12 voru meðhöndlaðir í öndunarvél, þar af tveir einnig í hjarta- og lungnavél. Enginn sjúklingur lést á gjörgæsludeild, en einn fjölveikur aldraður sjúklingur lést síðar á legudeild. Ályktanir: (1) Tíðni alvarlegra sjúkdómseinkenna af völdum inflúensu A (H1N1) sem leiða til gjörgæslumeðferðar er há á Íslandi. (2) Þessir sjúklingar fá flestir, auk annarra líffæratruflana, mjög alvarlega öndunarbilun sem oft lætur ekki undan hefðbundinni öndunarvélameðferð. (3) Árangur meðferðar á íslenskum gjörgæsludeildum hefur verið góður. (4) Niðurstöður þessarar rannsóknar geta nýst yfirvöldum við mat á meðferðarmöguleikum og fyrirbyggjandi aðgerðum gegn þessum lífshættulega sjúkdómi

Results of percutaneous coronary interventions in Iceland during 1987-1998

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenPurpose: To evaluate potential changes in clinical indications and the composition of the patient population undergoing percutaneous coronary intervention (PCI) in Iceland from 1987 to 1998. Furthermore, to assess changes in success rate and major complications for the procedure during the study interval in a small nation with one PCI centre. Material and methods: The first PCI was performed in Iceland in May 1987. A registry has been kept from the start that includes clinical and procedural data, and records of complications and mortality. During the study interval a total of 2440 PCIs were performed. The annual procedure rate was low at first, with a steep rise during the last years. Based on procedural changes over the years the study interval was divided into three periods: I. 1987-1992 (471 procedures); the learning years, II. 1993-1995 (796 procedures); increasing number of PCIs and the method established, III. 1996-1998 (1173 procedures); increasing use of stents and new antiplatelet regime used. Results: From period I to III, the rate of elective PCI declined from 82% to 52% (p<0.001), subacute procedures increased from 14% to 44% (p<0.001), acute PCI from 0.8% to 3% (p<0.05), and ad hoc procedures from 0.4% to 28% (p<0.001). This reflects an increase in PCI on patients with acute coronary syndromes, as the ratio of patiens with unstable angina increased from 15% to 36% (p<0.001). Also, 1-vessel PCI decreased proportionally from 93% to 83%, while 2 and 3 vessel procedures increased from 7% to 17% (p<0.001). The proportion of patients 70 years or older increased from 7% to 27% (p<0.001). Still, the success rate for PCI increased from 83% to 93% (p<0.001) and the use of stents rose sharply from 0% to 56%. The ratio of PCI due to restenosis declined somewhat between period II and III, from 15% to 12% (p=0.06). Simultaneously, the rate of acute coronary bypass surgery after PCI decreased from 4.2% to 0.2% (p<0.001) and significantly fewer patients had elevated creatinine kinase levels (4.0% vs 2.7%, respectively, p<0.05). However, clinical acute myocardial infarction after PCI remained similar at 1.3% and 0.9%, and the in hospital mortality was 0.6% and 0.4%. Conclusions: On a national basis the rate of PCI in Iceland is amongst the highest in Europe. Thus, in 1998, when the population in Iceland was 275,000, 453 PCIs were done (1647 procedures per million inhabitants). An increased number of subacute and acute PCIs is carried out, more complicated procedures are performed in patients with widespread disease, and the patient population is growing older. Still, the success rate is high and the frequency of complications and mortality relatively low.Markmið: Tilgangur rannsóknarinnar var að meta árangur kransæðavíkkana á Íslandi á tímabilinu 1987-1998. Ennfremur að kanna hugsanlegar breytingar á ábendingum fyrir kransæðavíkkunum og á sjúkdómsbakgrunni þeirra sjúklinga sem komu til aðgerðar og hvort breytingar hefðu orðið á árangri, tíðni fylgikvilla og aðgerðartengdum dauðsföllum. Efniviður og aðferðir: Frá því fyrsta kransæðavíkkunin var gerð hér á landi í maí 1987 hefur nákvæm skrá verið haldin yfir alla sjúklinga. Skráð voru aðalatriði úr sjúkrasögu, klínískt ástand sjúklings og aðalábending fyrir aðgerð, áættuþættir fyrir kransæðasjúkdómi, niðurstöður kransæðamyndatöku, tæknileg framkvæmd aðgerðarinnar, árangur, fylgikvillar og aðgerðartengd dauðsföll. Á árunum 1987-1998 voru alls gerðar 2440 kransæðavíkkanir. Rannsóknartímabilinu var skipt í þrjú tímaskeið: I. 1987-1992 (471 aðgerð); fyrstu lærdómsárin, II. 1993-1995 (796 aðgerðir); aukinn fjöldi aðgerða og aðferðin fest í sessi, III. 1996-1998 (1173 aðgerðir); vaxandi notkun stoðneta og ný blóðflöguhamlandi lyf notuð. Niðurstöður: Frá tímabili I til III minnkaði hlutfall valinna víkkunaraðgerða úr 82% í 52% (p<0,001), hálfbráðum víkkunum fjölgaði úr 14% í 44% (p<0,001), bráðum víkkunum úr 0,8% í 3% (p<0,05), og víkkunum í beinu framhaldi af kransæðamyndatöku fjölgaði úr 0,4% í 28% (p<0,001). Þessar breytingar endurspegla aukningu á víkkunaraðgerðum hjá sjúklingum með bráða kransæðasjúkdóma og hlutfall sjúklinga með hvikula hjartaöng jókst einnig úr 15% í 36% (p<0,001). Ennfremur lækkaði hlutfall víkkunaraðgerða á einni kransæð úr 93% í 83%, en jókst á tveimur og þremur æðum úr 7% í 17% (p<0,001). Sjúklingum 70 ára og eldri fjölgaði úr 7% í 27% (p<0,001). Samtímis jókst tíðni velheppnaðra víkkunaraðgerða úr 83% í 93% (p<0,001) og notkun stoðneta frá því að vera engin í 56%. Hlutfall sjúklinga sem komu til víkkunar vegna endurþrengsla lækkaði úr 15% í 12% (p=0,06). Jafnframt lækkaði tíðni bráðra hjáveituaðgerða vegna fylgikvilla við víkkun úr 4,2% í 0,2% (p<0,001), hækkun á hjartaensímum eftir víkkanir minnkaði úr 4,0% í 2,7% (p<0,05), en tíðni klínískt staðfests hjartadreps eftir víkkunaraðgerð hélst svipuð, 1,3% og 0,9%, svo og dánartíðni á sjúkrahúsi, sem var 0,6% og 0,4%. Ályktanir: Miðað við fólksfjölda er tíðni kransæðavíkkunaraðgerða á Íslandi með því hæsta í Evrópu. Árið 1998, þegar fólksfjöldi var 275.000, voru gerðar 453 aðgerðir, sem samsvarar staðlað 1647 aðgerðum á milljón íbúa. Á undanförnum árum hefur fjöldi hálfbráðra og bráðra víkkunaraðgerða aukist, fleiri æðar eru oftar víkkaðar í einu og hlutfall eldri sjúklinga fer vaxandi. Þrátt fyrir þetta er hlutfall velheppnaðra víkkunaraðgerða hátt og tíðni fylgikvilla og dauðsfalla eftir aðgerð lág

Modelling the 20th and 21st century evolution of Hoffellsjökull glacier, SE-Vatnajökull, Iceland

The Little Ice Age maximum extent of glaciers in Iceland was reached about 1890 AD and most glaciers in the country have retreated during the 20th century. A model for the surface mass balance and the flow of glaciers is used to reconstruct the 20th century retreat history of Hoffellsjökull, a south-flowing outlet glacier of the ice cap Vatnajökull, which is located close to the southeastern coast of Iceland. The bedrock topography was surveyed with radio-echo soundings in 2001. A wealth of data are available to force and constrain the model, e.g. surface elevation maps from ~1890, 1936, 1946, 1989, 2001, 2008 and 2010, mass balance observations conducted in 1936–1938 and after 2001, energy balance measurements after 2001, and glacier surface velocity derived by kinematic and differential GPS surveys and correlation of SPOT5 images. The approximately 20% volume loss of this glacier in the period 1895–2010 is realistically simulated with the model. After calibration of the model with past observations, it is used to simulate the future response of the glacier during the 21st century. The mass balance model was forced with an ensemble of temperature and precipitation scenarios derived from 10 global and 3 regional climate model simulations using the A1B emission scenario. If the average climate of 2000–2009 is maintained into the future, the volume of the glacier is projected to be reduced by 30% with respect to the present at the end of this century. If the climate warms, as suggested by most of the climate change scenarios, the model projects this glacier to almost disappear by the end of the 21st century. Runoff from the glacier is predicted to increase for the next 30–40 yr and decrease after that as a consequence of the diminishing ice-covered area

Minimalist C/case

This article discusses A-licensing and case from a minimalist perspective, pursuing the idea that argument NPs cyclically enter a number of A-relations, rather than just a single one, resulting in event-licensing, case-licensing and phi-licensing. While argument case commonly reflects Voice/v-relations, canonical A-movement is driven by higher elements, either in the C-T system or in a superordinate v-system (in ECM constructions). In addition, there is a distinction to be drawn between the triggering of A-movement, by for example C, and the licensing of the landing site, by for instance T, C-probing leading to tucking-in into Spec-T. Much of the evidence presented comes from quirky case constructions in Icelandic and from ECM and raising constructions in Icelandic and English. It is argued that T in ECM constructions inherits phi-licensing from the matrix v, regardless of the case properties of v

Nordic survey on assessment and treatment of fluid overload in intensive care

Funding Information: Acknowledgment to the physicians who helped with pretesting and supervision in the development of the survey: Maj Kjaergaard Kamper, Margrethe Duch Christensen, Lars Hein, Ulrik Skram, Dorthea Christensen, and Christian Sahl. Acknowledgment to the physicians who helped distribute the survey in their departments: Jon Henrik Laake, Christoffer Grant Sølling, Peter Toft, Elsebeth Haunstrup, Karina Baekby Houborg, Anne Højager Nielsen, Bodil Steen Rasmussen, Hansjörg Selter, Helle Scharling Pedersen, Mette Krag Vogelius, Thomas Strøm, Bjørn Mygil, Mads Kristian Holten, Michelle Chew, Per Martin Bådstøløkken, Johan Olsson, Erik Bruno, Thomas Kander, Nicklas Jonsson, Johan Mårtensson, Mattias Ringh, Anders, Paulsson, Christian Kahlbom, Marcus Castegren, Michael Haney, Karl Silvhamn, Minna Tallgren, Erika Wilkman, Sari Karlsson, Timo Porkkala, Stepani Bendel, Juha Koskenkari, Sami Mäenpää, Ari Alaspää, Tadeusz Kaminski, Johanna Kaunisto, Sanna-Maria Pohjanpaju, Björn Jäschke, Jouko Kähkönen and Antti Mäkelä, Eirik Alnes Buanes, Christian Magnus Langberg, Per Erik Ernø, Kay Rudi Karlsen, and Anne Cecilie Tvedten. Publisher Copyright: Copyright © 2022 Zeuthen, Wichmann, Schønemann-Lund, Järvisalo, Rubenson-Wahlin, Sigurðsson, Holen and Bestle.Introduction: Fluid overload in patients in the intensive care unit (ICU) is associated with higher mortality. There are few randomized controlled trials to guide physicians in treating patients with fluid overload in the ICU, and no guidelines exist. We aimed to elucidate how ICU physicians from Nordic countries define, assess, and treat fluid overload in the ICU. Materials and methods: We developed an online questionnaire with 18 questions. The questions were pre-tested and revised by specialists in intensive care medicine. Through a network of national coordinators. The survey was distributed to a wide range of Nordic ICU physicians. The distribution started on January 5th, 2022 and ended on May 6th, 2022. Results: We received a total of 1,066 responses from Denmark, Norway, Finland, Sweden, and Iceland. When assessing fluid status, respondents applied clinical parameters such as clinical examination findings, cumulative fluid balance, body weight, and urine output more frequently than cardiac/lung ultrasound, radiological appearances, and cardiac output monitoring. A large proportion of the respondents agreed that a 5% increase or more in body weight from baseline supported the diagnosis of fluid overload. The preferred de-resuscitation strategy was diuretics (91%), followed by minimization of maintenance (76%) and resuscitation fluids (71%). The majority declared that despite mild hypotension, mild hypernatremia, and ongoing vasopressor, they would not withhold treatment of fluid overload and would continue diuretics. The respondents were divided when it came to treating fluid overload with loop diuretics in patients receiving noradrenaline. Around 1% would not administer noradrenaline and diuretics simultaneously and 35% did not have a fixed upper limit for the dosage. The remaining respondents 63% reported different upper limits of noradrenaline infusion (0.05–0.50 mcg/kg/min) when administering loop diuretics. Conclusion: Self-reported practices among Nordic ICU physicians when assessing, diagnosing, and treating fluid overload reveals variability in the practice. A 5% increase in body weight was considered a minimum to support the diagnosis of fluid overload. Clinical examination findings were preferred for assessing, diagnosing and treating fluid overload, and diuretics were the preferred treatment modality.Peer reviewe

Summer eczema in exported Icelandic horses: influence of environmental and genetic factors

A cross sectional study was designed to estimate the prevalence of summer eczema (a chronic, recurrent seasonal dermatitis) in exported Icelandic horses and the influence of environmental and genetic factors on the development of the disease. Among 330 horses, which had been exported to Germany, Denmark and Sweden, 114 (34.5%) were found to have clinical signs of summer eczema. The prevalence was highest 2 years after export and the exposure to the biting midges Culicoides spp., was found to be the main risk factor for developing the disease. Genetic influence on the sensitivity for the disease was not established. It was concluded that exported Icelandic horses are predisposed for summer dermatitis and the fact that they are not introduced to the antigens of the biting midges early in live, due to it's absence in Iceland, is likely to explain the high prevalence of the disease after export