Prævalens af lungeemboli hos synkoperede patienter

Resume af originalartiklel vedr. prævalens af lungeemboli hos synkoperede patienterPrandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, Bucherini E, Visona A, Bova C, Imberti D et al: Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med 2016, 375(16):1524-1531

Multi-morbid patients with co-existing mental and physical illness

This review investigates the mortality gap that exists between people with or people without mental illness. Poor physical health is the leading cause of excess mortality among people with mental illness. Mental disorders increase the risk of developing a broad range of physical diseases and the risk of death caused by somatic diseases is increased. Also, mental disorder is associated with less optimal treatment in the somatic healthcare system, which is also evident within a broad spectrum of somatic diseases. The role of structural factors such as the design of the healthcare system and stigma are developing.</p

High Quality of Early Ischemic Stroke Care but Poorer Clinical Outcomes among Patients with a History of Mental Illness

Objectives. The aim of this study was to compare early stroke care and clinical outcomes among patients with and without a history of mental illness. Materials/Methods. A nationwide registry-based cohort study of patients with acute ischemic stroke treated in a tax-financed healthcare system. We used process and outcome measures from the Danish Stroke Registry 2007-2018 combined with the data from multiple Danish registries. We combined the process measures in two composite measures: an opportunity-based score (the proportion of all relevant process measures fulfilled for each patient) and an all-or-none score (the proportion of patients fulfilling all relevant process measures). Patients were categorized according to severity of mental health history. Results. We included 117 548 admissions with acute ischemic stroke: 20.8%, 3.5%, and 3.4% of admissions concerned patients with a history of minor, moderate, or major mental illness, respectively. Patients received a median of 85.7% (IQR, 66.7; 100.0) of the relevant processes (opportunity-based score). Patients with a history of mental illness were less likely to receive guideline-recommended acute stroke care within the defined time frames; however, differences were not clinically relevant. Patients with a history of mental illness were significantly more likely to die within 30 days, compared to patients with no history of mental illness: Risk ratios (RR) for 30-day mortality adjusted for age, sex, and country of origin were 1.31 (CI, 1.25; 1.37) for minor, 1.18 (CI, 1.05; 1.33) for moderate, and 1.44 (CI, 1.30; 1.60) for major mental illness. The corresponding adjusted RRs for recurrent stroke/TIA were 1.69 (CI, 1.58; 1.80) for minor, 1.39 (CI, 1.19; 1.61) for moderate, and 1.36 (CI, 1.17; 1.59) for major mental illness. The associations were weakened for 30-day mortality but not recurrent stroke/TIA after additional adjustment for potential mediating factors (comorbidity and stroke severity).Conclusion. More than one-quarter of patients with ischemic stroke had a history of mental illness. The overall performance of acute stroke care was high in all groups. Mental illness was associated with a higher risk of death and recurrent stroke compared to patients without a history of mental illness which may at least partly be due to a more adverse prognostic profile at the time of admission, including a higher stroke severity.</p

Godt nytår! – et tilbageblik på 2018

2018 blev et godt akademisk år i både Danmark og på den internationale scene. I Danmark er udpeget endnu tre professorer i akutmedicin, og flere er måske på vej? Tillykke til Mikkel Brabrand,Christian Backer Mogensen og Søren Mikkelsen (c) som blev udpeget som professorer i akutmedicin ved Syddansk Universitet i 2018.Bemærk desuden opslag af 5-årigt professorat i akutmedicin ved Københavns Universitet. Der er udgivet kilometervis af interessant læsning om akutmedicin i 2018. Redaktionen har samlet 9 internationale publikationer fra The Lancet, Annals of Emergency Medicine, New England Journal of Medicine, Circulation og BMJ Quality and Safety, som fokuserer på relevante akutmedicinske emner. Brug gennemgangen som refleksion over den daglige kliniske praksis, til undervisning i afdelingen, journal club eller inspiration til yderligere forskningen indenfor vores felt. Læs vores ultrakorte resumeer nedenfor, og klik videre i referencelisten, hvis du vil vide mere: Smertebehandling af akutte muskuloskeletale smerter: Kan vi nøjes med paracetamol uden at tillægge NSAID? Hvordan definerer vi AMI i 2019? Har du styr på type 1, 2, 3, 4a-c og 5 infarkt? Læs den nyeste universale konsensusdefinition. Skal vi skrue ned for ilt-behandlingen til den akut syge patient uden KOL, og stile efter en saturation på 94- 96% fremfor 96-100%? Bør vi give plasma fremfor NaCl præhospitalt til traumepatienten med hæmoragisk shock? Terminalbehandling i akutafdelingen – er vi klar til fremtiden? Mæslinger – er det relevant at overveje i Europa? Væskebehandling af ikke-kritisk syge patienter i akutafdelingen: Hvem kan have gavn af balanceret væskebehandling? Og kan vi nøjes med NaCl? Hvordan kan vi beskrive fejldiagnostisk og arbejde med patientsikkerhed indenfor en fælles forståelsesramme? Hvilke interventioner kan vi implementere for at fremme patientsikkerhedskulturen