| 11. |
- Alm, Fredrik, 1983-, et al.
(författare)
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Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 yearsMethod: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet
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| 12. |
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| 13. |
- Andersson Sundén, Erik, et al.
(författare)
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Evaluation of neutron spectrometer techniques for ITER using synthetic data
- 2013
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Ingår i: Nuclear Instruments and Methods in Physics Research Section A. - : Elsevier BV. - 0168-9002 .- 1872-9576. ; 701, s. 62-71
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Tidskriftsartikel (refereegranskat)abstract
- A neutron spectrometer at ITER is expected to provide estimates of plasma parameters such as ion temperature, Ti, fuel ion ratio, nt/nd, and Qthermal/Qtot, with 10-20% precision at a time resolution, Δt, of at least 100 ms. The present paper describes a method for evaluating different neutron spectroscopy techniques based on their instrumental response functions and synthetic measurement data. We include five different neutron spectrometric techniques with realistic response functions, based on simulations and measurements where available. The techniques are magnetic proton recoil, thin-foil proton recoil, gamma discriminating organic scintillator, diamond and time-of-flight. The reference position and line of sight of a high resolution neutron spectrometer on ITER are used in the study. ITER plasma conditions are simulated for realistic operating scenarios. The ITER conditions evaluated are beam and radio frequency heated and thermal deuterium-tritium plasmas. Results are given for each technique in terms of the estimated time resolution at which the parameter determination can be made within the required precision (here 10% for Ti and the relative intensities of NB and RF emission components). It is shown that under the assumptions made, the thin-foil techniques out-perform the other spectroscopy techniques in practically all measurement situations. For thermal conditions, the range of achieved Δt in the determination of Ti varies in time scales from ms (for the magnetic and thin-foil proton recoil) to s (for gamma discriminating organic scintillator).
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| 14. |
- Andersson Sundén, Erik, et al.
(författare)
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Instrumentation for neutron emission spectrometry in use at JET
- 2010
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Ingår i: Nuclear Instruments and Methods in Physics Research Section A. - : Elsevier BV. - 0168-9002 .- 1872-9576. ; 623:2, s. 681-685
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Tidskriftsartikel (refereegranskat)abstract
- The present contribution discusses two neutron spectrometers: the time-of-flight spectrometer (TOFOR) and the magnetic proton recoil spectrometer (MPRu). TOFOR uses fast plastic scintillators equipped with digital time-stamping electronics to register the time of each eligible scintillation event. The time trace for each detector is acquired practically dead-time free. The detectors of the MPRu are of phoswich type and each detector is connected to a digital transient recorder card that stores the full waveform for an event. By using phoswich detectors, pulse-shape discrimination techniques can be applied offline to distinguish signal events from background. A future upgrade of TOFOR could be digital “hybrid” cards, which store correlated time and waveform information. This information can be used to decrease the background level in the ttof spectrum, thereby increasing the operating range.
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| 15. |
- Andersson Sundén, Erik, et al.
(författare)
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The thin-foil magnetic proton recoil neutron spectrometer MPRu at JET
- 2009
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Ingår i: Nuclear Instruments and Methods in Physics Research Section A. - : Elsevier BV. - 0168-9002 .- 1872-9576. ; 610:3, s. 682-699
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Tidskriftsartikel (refereegranskat)abstract
- Neutrons are produced in fusion energy experiments with both deuterium (D) and deuterium–tritium (DT) plasmas. Neutron spectroscopy is a valuable tool in the study of the underlying fuel ion populations. The magnetic proton recoil neutron spectrometer, originally installed at JET in 1996 for 14-MeV neutron measurements, has been upgraded, with the main aim of improving its signal-to-background ratio (S/B), making measurements of the 2.5-MeV neutron emission in D plasmas possible. The upgrade includes a new focal-plane detector, based on the phoswich technique and consequently less sensitive to background, and a new custom-designed digital data acquisition system based on transient recorder cards. Results from JET show that the upgraded MPRu can measure 2.5-MeV neutrons with S/B=5, an improvement by a factor of 50 compared with the original MPR. S/B of 2.8×104 in future DT experiments is estimated. The performance of the MPRu is exemplified with results from recent D plasma operations at JET, concerning both measurements with Ohmic, ion cyclotron resonance (ICRH) and neutral beam injection (NBI) plasma heating, as well as measurements of tritium burn-up neutrons. The upgraded instrument allows for 2.5-MeV neutron emission and deuterium ion temperature measurements in plasmas with low levels of tritium, a feature necessary for the ITER experiment.
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| 16. |
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| 17. |
- Ansari, Shaquib Rahman, et al.
(författare)
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Pharmaceutical Quality by Design Approach to Develop High-Performance Nanoparticles for Magnetic Hyperthermia
- 2024
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Ingår i: ACS Nano. - 1936-0851 .- 1936-086X. ; 18:23, s. 15284-15302
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Tidskriftsartikel (refereegranskat)abstract
- Magnetic hyperthermia holds significant therapeutic potential, yet its clinical adoption faces challenges. One obstacle is the large-scale synthesis of high-quality superparamagnetic iron oxide nanoparticles (SPIONs) required for inducing hyperthermia. Robust and scalable manufacturing would ensure control over the key quality attributes of SPIONs, and facilitate clinical translation and regulatory approval. Therefore, we implemented a risk-based pharmaceutical quality by design (QbD) approach for SPION production using flame spray pyrolysis (FSP), a scalable technique with excellent batch-to-batch consistency. A design of experiments method enabled precise size control during manufacturing. Subsequent modeling linked the SPION size (6–30 nm) and composition to intrinsic loss power (ILP), a measure of hyperthermia performance. FSP successfully fine-tuned the SPION composition with dopants (Zn, Mn, Mg), at various concentrations. Hyperthermia performance showed a strong nonlinear relationship with SPION size and composition. Moreover, the ILP demonstrated a stronger correlation to coercivity and remanence than to the saturation magnetization of SPIONs. The optimal operating space identified the midsized (15–18 nm) Mn0.25Fe2.75O4 as the most promising nanoparticle for hyperthermia. The production of these nanoparticles on a pilot scale showed the feasibility of large-scale manufacturing, and cytotoxicity investigations in multiple cell lines confirmed their biocompatibility. In vitro hyperthermia studies with Caco-2 cells revealed that Mn0.25Fe2.75O4 nanoparticles induced 80% greater cell death than undoped SPIONs. The systematic QbD approach developed here incorporates process robustness, scalability, and predictability, thus, supporting the clinical translation of high-performance SPIONs for magnetic hyperthermia.
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| 18. |
- Barlow, Lotti, et al.
(författare)
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Nationellt fackspråk för vård och omsorg : Slutrapport
- 2011
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Rapport (populärvet., debatt m.m.)abstract
- SammanfattningEtt tillgängligt och använt nationellt fackspråk ska bidra till en god och säker vård och omsorg. Det ska även medverka till att kvaliteten och resultaten på området ska kunna följas upp och jämföras på ett mer effektivt sätt. Slutrapporten presenterar resultatet av projektet Nationellt fackspråk för vård och omsorg samt förslag till förvaltning och utveckling.ResultatetResultatet innefattar bland annat att det internationella begreppssystemet Snomed CT är översatt till svenska och att det är förberett för förvaltning och distribution. Socialstyrelsen har även tagit fram och testat metoder för förvaltning och utveckling av det nationella fackspråket i sin helhet. Därtill har representanter för målgrupperna informerats och fått kunskap.Rapporten innehåller en utförlig beskrivning av det nationella fackspråkets sammantagna innehåll: Socialstyrelsens termbank, klassifikationer och kodverk, den svenska versionen av Snomed CT, metoder för utveckling och förvaltning samt regler för användning.Förvaltning, införande och resursbehovI rapporten finns förslag till hur hela det nationella fackspråket kan tas omhand av Socialstyrelsen och hur det kan införas i vården och omsorgen. Projektets övergång till en långsiktigt hållbar organisation kräver resurser. Därför redogör rapporten för det förväntade resursbehovet för förvaltning och utveckling. Bland annat föreslås en treårig utbildningsinsats samt stimulansbidrag för införande.Krav på styrning, samordning och förtydligat ansvarRapporten betonar behovet av en samlad och medveten styrning av utvecklingen inom området. Socialstyrelsen vill ha en samordnande roll i utvecklingen och förvaltningen av det nationella fackspråket. Myndigheten föreslås få det initiala ansvaret för att utbilda användare och att driva frågor om det nationella fackspråket.Vidare vill Socialstyrelsen få ett uttalat mandat att samordna de nationella aktiviteter som drivs med koppling till Snomed CT. Rapporten pekar ut några särskilt prioriterade områden som myndigheten borde få i uppdrag att arbeta vidare inom.Kunskapsstyrning och normgivningEn viktig slutsats i rapporten är att användningen av det nationella fackspråket behöver regleras för att målet om ökad säkerhet för klienter och patienter ska kunna uppnås. I dagsläget bedöms föreskrifter vara den metod som bäst kan garantera ett brett genomförande.Målgrupper för slutrapportenSlutrapporten riktar sig till beslutsfattare i kommuner och landsting, vård- och omsorgspersonal med särskilt intresse eller ansvar för dokumentationsfrågor och professionella organisationer. Den riktar sig också till terminologiansvariga i kommuner och landsting, IT-direktörer, IT-leverantörer samt aktörer inom den nationella strategin för eHälsa.
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| 19. |
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| 20. |
- Becirovic-Agic, Mediha, et al.
(författare)
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Time course of decompensation after angiotensin II and high-salt diet in Balb/CJ mice suggests pulmonary hypertension-induced cardiorenal syndrome
- 2019
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Ingår i: American Journal of Physiology. Regulatory Integrative and Comparative Physiology. - : the American Physiological Society. - 0363-6119 .- 1522-1490. ; 316:5, s. R563-R570
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Tidskriftsartikel (refereegranskat)abstract
- The genetic background of a mouse strain determines its susceptibility to disease. C57BL/6J and Balb/CJ are two widely used inbred mouse strains that we found react dramatically differently to angiotensin II and high-salt diet (ANG II + Salt). Balb/CJ show increased mortality associated with anuria and edema formation while C57BL/6J develop arterial hypertension but do not decompensate and die. Clinical symptoms of heart failure in Balb/CJ mice gave the hypothesis that ANG II + Salt impairs cardiac function and induces cardiac remodeling in male Balb/CJ but not in male C57BL/6J mice. To test this hypothesis, we measured cardiac function using echocardiography before treatment and every day for 7 days during treatment with ANG II + Salt. Interestingly, pulsed wave Doppler of pulmonary artery flow indicated increased pulmonary vascular resistance and right ventricle systolic pressure in Balb/CJ mice, already 24 h after ANG II + Salt treatment was started. In addition, Balb/CJ mice showed abnormal diastolic filling indicated by reduced early and late filling and increased isovolumic relaxation time. Furthermore, Balb/CJ exhibited lower cardiac output compared with C57BL/6J even though they retained more sodium and water, as assessed using metabolic cages. Left posterior wall thickness increased during ANG II + Salt treatment but did not differ between the strains. In conclusion, ANG II + Salt treatment causes early restriction of pulmonary flow and reduced left ventricular filling and cardiac output in Balb/CJ, which results in fluid retention and peripheral edema. This makes Balb/CJ a potential model to study the adaptive capacity of the heart for identifying new disease mechanisms and drug targets.
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