Changes in colloid solution sales in Nordic countries.

BACKGROUND: Administration of resuscitation fluid is a common intervention in the treatment of critically ill patients, but the right choice of fluid is still a matter of debate. Changes in medical practice are based on new evidence and guidelines as well as traditions and personal preferences. Official warnings against the use of hydroxyl-ethyl-starch (HES) solutions have been issued. Nordic guidelines have issued several strong recommendations favouring crystalloids over colloids in all patient groups. Our objective was to describe the patterns of colloid use in Nordic countries from 2012 to 2016. METHODS: The data were obtained from companies that provide pharmaceutical statistics in different countries. The data are sales figures from pharmaceutical companies to pharmacies and health institutions. RESULTS: We found a 56% reduction in the total sales of all colloids in Nordic countries over a 5-year period. These findings were mainly related to a 92% reduction in the sales of HES solutions. A reduction in sales of other synthetic colloids has also occurred. During the same period, we found a 46% increase in albumin sales, but these numbers varied between Nordic countries. CONCLUSION: The general reduction in colloid sales likely reflects the recommendation that colloids should be used only in special circumstances. The dramatic reduction in the sales of HES solutions was expected given evidence of harm and the official warnings. The steady increase in albumin sales and the notable differences between the five Nordic countries cannot be explained.

Patient reactions to specialist telemedicine consultations--a sociological approach.

A sociological study was made of patient experiences of telemedical specialist consultations in northern Norway. The study made use of a qualitative methodological approach. The data were collected through unstructured in-depth interviews of patients or the parents of very young patients. The patients were referred for a telemedical otolaryngology consultation in a randomly selected period of three months. Of a total of 35 patients, 15 refused to participate in the study. Of the 20 remaining, three were excluded for practical and financial reasons. The telemedicine consultation consisted of a general practitioner examining patients endoscopically and realtime transmission of the examination to a specialist by means of a videoconferencing system. Video-communication seemed to restrict personal contact with the specialist. In spite of that, it was not the video-communication itself but the social situation that mattered to the patients. Compared with an ordinary medical consultation, a telemedical consultation represented a wider interaction system, with more channels for access, inspection and information, which gave the patients different options for participation in the consultation.