Nordisk medicin最新文献

The concept of a merit profile has been evolved at Karolinska Institute in Stockholm, whereby not only research achievements but also teaching, administrative and clinical skills and experience are each given merit ratings to produce an individual profile. This approach is based on the notion that all of these fields of activity constitute integregal facets of a scat of higher learning in medicine, and that a candidate's relative merits in each of these areas should be seen not only in relation to the overall academic goals but also to practical, professional considerations. The merit profile is intended to be used in selection for appointments and promotion, and as a basis for the continued enhancement of individual competence, and salary review.

Every tenth patient discharged from a medical department at a general hospital in Sweden during the period, 1992-1994, required emergency re-admission within 14 days. The risk of re-admission appeared to be unrelated to the duration of hospitalisation before discharge or to the occupancy rate. However, a high risk of emergency re-admission was found to be associated with four diagnoses: acute myocardial infarction, angina pectoris, heart failure and chronic obstructive lung disease. Plans are under way to launch a multicentre intervention study of emergency re-admission to departments of medicine.

This review provides an account of the present situation as reflected by findings in recent studies, which illustrate epidemiological, clinical and metabolic aspects of thrombosis associated with oral contraceptive (OC) usage. With the reduction of the oestrogen content of OCs, the relative risk for acute myocardial or cerebral thrombosis is now 1.5-3. Low-dose OCs containing third generation gestagens seem to be associated with less risk of infarction, and possibly of cerebral thrombosis, than are OCs containing second generation gestagens. The risk of venous thrombosis is increased 2-4-fold in conjunction with the usage of low-dose OCs with second generation gestagens, and possibly slightly more (3-5-fold) in conjunction with OCs containing third generation gestagens, though this is of small clinical significance. When prescribing OCs for women at an increased risk of venous thrombosis, a low-dose pill with a second generation progestagen seems to be preferable. If OCs are prescribed to women at an increased risk of arterial thrombosis, OCs with third generation progestagens seem to be a reasonable first choice. Women with no thrombotic predisposion can safely use any type of low-dose OCs [corrected].

A retrospective study is accomplished in Iceland to study whether mortality and cancer incidence among male physicians (1,210) were lower than those among men of the general population and lawyers (1,032). Overall mortality among lawyers was similar to that of the general male population, however, mortality among the physicians was lower than that of the general population and the lawyers, due to lower mortality for all cancers (SMR 0.73), cerebrovascular diseases (SMR 0.53) and respiratory diseases (SMR 0.54). The physicians had higher mortality for suicide committed by drugs, solid or liquid substances. Cancer was not as frequent among the physicians as among the lawyers, particularly for lung cancer, the SIR was 0.45, but the rates were higher for cancer of the colon and brain among the physicians than among others.

The development of red cell substitute oxygen-carriers has reached a stage where stroma-free haemoglobin solutions (SFHSs) and perfluorocarbon-based substitutes are undergoing clinical trials. However, there is no evidence to suggest that such products will become available, other than for restricted, well-defined indications. Where SFHSs are concerned, the supply of haemoglobin, the strictly limited shelf-life, and the short intravascular half-life are the most important problems to be solved, whereas the use of perfluorocarbons is limited, in particular due to the need of positive pressure ventilation to maintain high oxygen tension. Red cell substitutes for general use will remain a dream in the foreseeable future. Measures to enhance blood preservation and to promote the optimal use of blood products will be the most important areas of transfusion research in the immediate future.

The article consists of a synthesis of a rheumatic pain symposium held at the annual meeting of the Swedish Medical Association in 1996. Various aspects of pain in rheumatic diseases were discussed, such as physiological, neurohumoral and neurogenic mechanisms, sensory stimulation treatment, differentiation of mechanical and inflammatory pain, quality enhancement by improved co-operation between primary and tertiary care facilities, pharmacological treatment with (centrally and peripherally acting) opioids, selective cyclo-oxygenase inhibitors, and NMDA (N-methyl-D-aspartate) receptor antagonists. For patients with rheumatic disorders exacerbated by pain problems, as for other patients, a pain diagnosis is of fundamental importance. This can be achieved by analysis of the social, psychological, physiological and medical factors contributing to the cause and degree of pain and to pain behaviour, and of the extent to which the pain may be nociceptive (i.e., inflammatory, mechanical, or ischaemic in origin), neurogenic or idiopathic. Pain analysis should be followed by individualised treatment focused on the patient's most crucial problems, thus enhancing the prospect of optimal treatment outcome.