AimObesity and especially hypertrophy of epicardial adipose tissue accelerate coronary atherogenesis. We aimed at comparing levels of inflammatory and atherogenic hormones from adipose tissue in the pericardial fluid and circulation of cardiovascular disease patients.Methods and ResultsVenous plasma (P) and pericardial fluid (PF) were obtained from elective cardiothoracic surgery patients (n = 37). Concentrations of leptin, adipocyte fatty acid-binding protein (A-FABP) and adiponectin (APN) were determined by enzyme-linked immunosorbent assays (ELISA). The median concentration of leptin in PF (4.3 (interquartile range: 2.8–9.1) μg/L) was comparable to that in P (5.9 (2.2–11) μg/L) and these were significantly correlated to most of the same patient characteristics. The concentration of A-FABP was markedly higher (73 (28–124) versus 8.4 (5.2–14) μg/L) and that of APN was markedly lower (2.8 (1.7–4.2) versus 13 (7.2–19) mg/L) in PF compared to P. APN in PF was unlike in P not significantly related to age, body mass index, plasma triglycerides or coronary artery disease. PF levels of APN, but not A-FABP, were related to the size of paracardial adipocytes. PF levels of APN and A-FABP were not related to the immunoreactivity of paracardial adipocytes for these proteins.ConclusionIn cardiac and vascular disease patients, PF is enriched in A-FABP and poor in APN. This adipokine microenvironment is more likely determined by the heart than by the circulation or paracardial adipose tissue.
Aim Prompt and accurate aetiological diagnostics are needed if physicians are to improve and target antibiotic treatment. We aimed to investigate whether antibiotic‐prescribing decisions are improved with availability of point‐of‐care polymerase chain reaction (POC‐PCR) diagnostic testing of children with suspected respiratory tract infection, and if it had an impact on referral for additional medical procedures. Methods This was a single‐centre one‐group pre‐test–post‐test study. Children visiting our paediatric department with respiratory tract infection symptoms were included if the treating paediatrician was considering an antibiotic prescription. Throat swabs were analysed for pathogens using POC‐PCR. The paediatrician registered treatment decisions, referrals for additional procedures and decisions about hospitalisation into a questionnaire before and after receiving the POC‐PCR results. Results We included 95 children. The availability of results from POC‐PCR analysis significantly changed the prescribed antibiotic treatment to non‐antibiotic treatment in 46% (36%–56%) of the children and the reverse in 2% (1%–8%). Paediatricians referred significantly fewer patients to additional medical procedures with availability of POC‐PCR. Conclusion POC‐PCR significantly reduced the odds of antibiotic prescription and referral for additional medical procedures. Thus, POC‐PCR presents an opportunity to improve antibiotic‐prescribing practices if it is combined with standard clinical evaluation.
Baggrund: I 2018 blev akutmedicin et selvstændigt speciale (1). Målbeskrivelsen er udarbejdet af sundhedsstyrelsen (SST), Dansk Selskab for Akutmedicin (DASEM) og en række andre specialer. Dernæst er kompetencekortene til de 9 kompetencer udarbejdet af DASEM (2). De uddannelsesansvarlige overlæger har lokalt udarbejdet uddannelsesprogrammer, som definerer hvordan de 9 kompetencer opnås i hver enkelt akutafdeling. Andre specialer har god erfaring med at supplerer med specifikke færdighedskort som fx kan benyttes til at superviser praktiske kliniske procedurer. Formål: Yngre Danske Akutmedicinere (YDAM) afviklede i marts 2019 første nationale uddannelsesdag. Formålet med dagen var at erfaringsudveksle på tværs af hospitaler samt samle input til DASEM med henblik på revision af målbeskrivelsen, kompetencekort samt udarbejdelse af nye færdighedskort. Metode: Der blev afholdt et endags seminar for alle uddannelseslæger og uddannelsesansvarlige overlæger i akutmedicin. Dagen bestod af gruppearbejde, hvor målbeskrivelsen, kompetencekort og uddannelsesprogrammer blev gennemgået kritisk og der blev opstillet forslag til evt. forbedringstiltag. Resultat: Der var 36 deltagere på uddannelsesdagen, heraf 9 overlæger og 27 uddannelseslæger. Der var bred deltagelse på dagen med uddannelseslæger fra alle regioner men ikke alle 21 akutsygehuse. Alle kom med input til forbedring af målbeskrivelse og kompetencekort. Dette blev samlet i et fælles dokument. Der blev opstillet 14 forslag til nye færdighedskort. Konklusion: Uddannelsesdagen klarlagde at der blandt yngre læger og uddannelsesansvarlige overlæger er et ønske om at uddannelsesmaterialet opdateres for at forbedre den akutmedicinske introduktionsuddannelse. For at øge det faglige niveau, ønskede deltagerne bl.a opdatering af kompetencekort samt nye færdighedskort. De akutmedicinske læger som har grundlagt DK-AKUT, er allerede i gang med dette arbejde og man bør i samarbejde med dem opdaterer kompetencekort og færdighedskort efter international standard.
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