| 31. |
- Gillespie, Ulrika, et al.
(författare)
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Effects of Pharmacists' Interventions on Appropriateness of Prescribing and Evaluation of the Instruments' (MAI, STOPP and STARTs') Ability to Predict Hospitalization-Analyses from a Randomized Controlled Trial
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:5, s. e62401-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Appropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period. Methods: The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I) n = 182, control group (C) n = 186). The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed. Results: The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01). The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001). The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001). There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively). No association was detected between the scores of the tools and total re-visits to hospital. Conclusion: The interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.
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| 32. |
- Gillespie, Ulrika, et al.
(författare)
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Effects of pharmacists’ interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes : analyses from a randomized controlled trial
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background:Inappropriate prescribing can cause substantial morbidity and represents a clinical and economic burden for patients and society. Appropriateness of prescribing can be assessed by various measures and screening tools, however, for a tool to be valid there should be casual links to important clinical health outcomes. The aim of this study was to investigate the effect of a pharmacist intervention on appropriateness of prescribing, and to explore the relationship between these results and clinical health outcomes defined as re-visits to hospital.Methods:The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalisation was investigated, was used. The criteria from the validated instruments STOPP, START and MAI were applied retrospectively to the study patients (368 patients; intervention group n=182, control group n=186). The quality assessments were done on admission and at discharge to detect differences over time between the control- and the intervention group. Hospital care consumption one year after admission was recorded and the correlation between scores for appropriateness, as well as number of drugs at discharge, and hospital visits was analysed.Results:The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for the intervention group but not for the control group (1.42 and 0.93 vs. 1.46 and 1.66 respectively, p<0.01) The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for the intervention group but not for the control group (0.36 and 0.09 vs. 0.42 and 0.45 respectively, p<0.001). The summated score for MAI was reduced for the intervention group but not for the control group (8.5 to 5.0 and 8.7 to 10.0 respectively, p< 0.001). There was no correlation between the scores of the tools and total visits to hospital. Number of drugs (unadjusted) correlated with visits to hospital and the rate ratio was 4%. For readmissions to hospital, MAI (unadjusted) and the number of drugs showed a positive correlation. There was a correlation between MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively).Conclusion:The addition of a comprehensive pharmacist service to standard care significantly improved the appropriateness of prescribing for patients in the intervention group that participated in the randomized controlled trial, as evaluated by all three instruments used; STOPP, START and MAI. However, the results on correlation between the tools and re-visits to hospital were inconclusive.
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| 33. |
- Hammarlund, Dan
(författare)
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A Distinct Delta-C-13 Decline in Organic Lake-Sediments at the Pleistocene-Holocene Transition in Southern Sweden
- 1993
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Ingår i: Boreas. - 1502-3885. ; 22:3, s. 236-243
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Tidskriftsartikel (refereegranskat)abstract
- Values of deltaC-13 obtained from conventional bulk sediment radiocarbon dates encompassing the Pleistocene-Holocene boundary have been compiled and plotted against C-14 age. In all, 286 lake sediment dates from southern Sweden in the range 8,000 to 13.000 BP have been evaluated. A significant decrease in deltaC-13 values, initiated shortly before 10,000 BP and amounting to 5 parts per thousand, is distinguished. This change is accompanied by increased limnic productivity, decreased erosive input and increased organic carbon content of the sediments. A probable explanation for the deltaC-13 decline in organic material is decreased importance of dissolution of silicates at the transition to the Holocene. During the Late Weichselian, extensive weathering of exposed minerogenic material with subsequent input of bicarbonate to the lake water may have caused a relative enrichment of C-13 in dissolved inorganic carbon. Furthermore, the early Holocene increase in terrestrial vegetation cover probably led to an increased supply of C-13 depleted carbon dioxide to the lake water by root respiration. Altered limnic vegetation, presumably towards increased production of phytoplankton, could also have contributed to the observed decreasing deltaC-13 trend. The importance of these processes compared to other possible influencing factors, mainly endogenic carbonate production and changes in the global carbon cycle, is discussed.
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| 34. |
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| 35. |
- Hammarlund, Dan, et al.
(författare)
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A Late Weichselian stable isotope and molluscan stratigraphy from southern Sweden
- 1994
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Ingår i: GFF. - 2000-0863. ; 116:4, s. 235-248
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Tidskriftsartikel (refereegranskat)abstract
- Late Weichselian and early Holocene partly carbonate-rich sediments from a small lacustrine deposit in Skane, southern Sweden, were analysed for stable carbon and oxygen isotopes and mollusc assemblages. The data from these analyses reveal a pronounced climatic warming at c. 12,400 BP, accompanied by a general change from continental to maritime conditions. Two significant climatic oscillations were identified, dated ate. 12,200-12,000 BP ande. 11,000-10,200 BP. The climatic cooling of the latter, corresponding to the Younger Dryas stadial, may have been initiated well before 11,000 BP. A climatic oscillation of minor amplitude may have occurred around 11,500 BP. Distinct variations in delta(13)C of bulk organic material and shell carbonate are discussed in terms of climatically-induced changes in lake-water chemistry. The general assumption of a positive correlation between delta(18)O of limnic carbonates and mean annual air temperature is questioned. A climatic warming may be associated with a depletion of (18)O in limnic carbonates. Comparisons of palaeoclimatic information from the stable isotope data with that provided by molluscs allow the identification of aspects of climatic and environmental change such as water temperature, water depth, and aquatic vegetation density. Changes in the mollusc assemblage reflect changes in the limnic environment and facilitates the interpretation of stable isotope data.
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| 36. |
- Hammarlund, Dan, et al.
(författare)
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A Late Weichselian Stable-Isotope Stratigraphy Compared with Biostratigraphical Data - A Case-Study from Southern Sweden
- 1994
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Ingår i: Journal of Quaternary Science. - : Wiley. - 1099-1417 .- 0267-8179. ; 9:1, s. 13-31
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Tidskriftsartikel (refereegranskat)abstract
- Late Weichselian lake sediments from a site in southern Sweden, were analysed for stable carbon and oxygen isotopes, as well as plant macrofossils and insect remains. By comparison of independent data sets, general climatic changes were demonstrated. Lithological, chemical and stable isotope data reveal two significant climatic oscillations at ca. 12 200-12 000 and ca. 11 000-10 200 yr BP respectively. Continental climatic conditions, indicated by evaporative enrichment of O-18 in lake marl, characterise parts of the early lake history, including the Older Dryas Stadial. Distinct variations of deltaC-13 in organic material is discussed in terms of climatically induced changes in lake-water chemistry. Different types of photosynthetic assimilation of dissolved inorganic carbon is proposed as a contributing factor influencing lake marl deltaC-13. The universal application of a positive correlation between lake marl deltaO-18 and mean annual air temperature is questioned. Quantifications of mean summer and winter temperatures based on beetle analysis show a climatic optimum around 12 000 yr BP, a marked cooling around 11 000 yr BP and a strong amelioration at ca. 10 200 yr BP. These climatic events were accompanied by distinct changes in aquatic vegetation. Plant macrofossil and insect analyses indicate an open vegetation during the entire period studied. Biostratigraphical data reflecting local limnic and terrestrial vegetation and regional climate facilitate the interpretation of stable isotope data.
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| 37. |
- Hammarlund, Dan, et al.
(författare)
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A sedimentary record of the rise and fall of the metal industry in Bergslagen, south central Sweden
- 2008
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Ingår i: Journal of Paleolimnology. - : Springer Science and Business Media LLC. - 0921-2728 .- 1573-0417. ; 39:4, s. 463-475
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Tidskriftsartikel (refereegranskat)abstract
- Detailed stratigraphic analyses of sediments deposited in Lake Botjarnen, a small boreal forest lake in the shield terrain of central Sweden, clearly reflect progressively increasing human impact on terrestrial and aquatic ecosystems following settlement and establishment of an iron industry in the 17th century. Rising frequencies of pollen and spores from light-demanding plants provide evidence of extensive forest clearance for charcoal and timber production, which peaked in the early 20th century. An associated increase in catchment erosion is reflected by changing carbon and nitrogen elemental content and carbon-isotope composition of sediment organic matter and by increased magnetic susceptibility of the sediments. Records of air-borne pollutants (lead, zinc and sulphur) can be correlated to the development of local and regional mining and metal industry as inferred from historical accounts. Rapid recession of the iron industry led to re-forestation and recovery of the aquatic nutrient status to pre-industrial conditions over the past 100 years. The chronology of the sediment succession, which is based on Pb-210 and Cs-137 radionuclide data in combination with radiocarbon dating, is confirmed by historical lead pollution trends established for the region.
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| 38. |
- Hammarlund, Dan, et al.
(författare)
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Climate and environment during the Younger Dryas (GS-1) as reflected by composite stable isotope records of lacustrine carbonates at Torreberga, southern Sweden
- 1999
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Ingår i: Journal of Quaternary Science. - 1099-1417. ; 14:1, s. 17-28
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Tidskriftsartikel (refereegranskat)abstract
- Climatic and environmental changes during the Younger Dryas stadial (GS-1) and preceding and following transitions are inferred from stable carbon and oxygen isotope records obtained from the sediments of ancient Lake Torreberga, southern Sweden. Event GS-1 is represented in the sediment sequence by 3.5 m of clay containing lacustrine carbonates of various origins. Comparison of isotopic records obtained on mollusc shells, ostracod valves, and Chara encrustations precipitated during specific seasons of the year supports estimates of relative changes in both lake water and mean annual air temperatures. Variations in soil erosion rates can also be estimated from a simple isotope-mass-balance model to separate allochthonous and autochthonous carbonate contributions to the bulk carbonate content of the sediments. The well-known, rapid climatic shifts characterising the Last Termination in the North Atlantic region are clearly reflected in the isotopic data, as well as longer-term changes within GS-1. Following maximum cooling shortly after the Allerod-Younger Dryas (GI-1-GS-1) transition, a progressive warming and a slight increase in aquatic productivity is indicated. At the Younger Dryas-Preboreal (GS-1-PB) transition mean annual air temperature rapidly increased by more than 5 degrees C and summer lake-water temperature increased by ca. 12 degrees C. The subsequent Preboreal oscillation is characterised by an increase in soil erosion and a slight decrease in mean annual air temperature. These results are in harmony with recent findings about large-scale climate dynamics during the Last Termination. Copyright (C) 1999 John Wiley & Sons, Ltd.
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| 39. |
- Hammarlund, Dan, et al.
(författare)
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Holocene changes in atmospheric circulation recorded in the oxygen-isotope stratigraphy of lacustrine carbonates from northern Sweden
- 2002
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Ingår i: The Holocene. - : SAGE Publications. - 0959-6836 .- 1477-0911. ; 12:3, s. 339-351
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Tidskriftsartikel (refereegranskat)abstract
- The oxygen-isotope composition of local precipitation (delta(18)O(P)) is reconstructed from carbonate lake-sediment components in a sediment core covering the last 10000 calendar years from Lake Tibetanus, a small, hydrologically open, groundwater-fed take in the Abisko area, northern Sweden. Comparison of the delta(18)O(P) history with a pollen-based palaeotemperature record from the same core clearly reveals pronounced deviations from the normally expected temporal delta(18)O(P)-temperature relation (so-called 'Dansgaard relation') that may be a function of changing oceanicity. The transition from relatively moist, maritime conditions in the early Holocene to a much drier climate after 6500 cal. BP is reflected by major changes in forest extent and composition as recorded by pollen and plant macrofossil data. At the time of maximum influence of westerly air-mass circulation (high zonal index) c. 9500 cal. BP, brought about by high summer insolation and enhanced meridional pressure gradients. delta(18)O(P) at Lake Tibetanus was about 2%, higher than would be predicted by the modem isotope-temperature relation, The occurrence of long-term changes in delta(18)O(P)-temperature relations, which are more sensitive measures of palaeoclimate than either delta(18)O(P) or temperature alone, needs to be taken into account when extracting palaeoclimatic information from continental oxygen-isotope records.
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| 40. |
- Hammarlund, Dan, et al.
(författare)
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Late Holocene expansion of Siberian dwarf pine (Pinus pumila) in Kamchatka in response to increased snow cover as inferred from lacustrine oxygen-isotope records
- 2015
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Ingår i: Global and Planetary Change. - : Elsevier BV. - 0921-8181 .- 1872-6364. ; 134:SI, s. 91-100
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Tidskriftsartikel (refereegranskat)abstract
- Holocene records of cellulose-inferred lake-water δ18O were produced from two lake-sediment sequences obtained in central and northern Kamchatka, Russian Far East. The sediment records share similar fluctuations in δ18O during the interval of ca. 5000-800calyr BP that correspond (inversely) with changes in K+ content of the GISP2 ice-core record from Greenland, a proxy for the relative strength of the Siberian High, suggesting control by climate-related variability in δ18O of regional precipitation. The dramatic expansion of Siberian dwarf pine (Pinus pumila) in northern and central Kamchatka between ca. 5000 and 4000calyr BP, as inferred from pollen records from the same and neighbouring sites, appears to have occurred at a time of progressively declining δ18O of precipitation. This development is interpreted as reflecting a regional cooling trend accompanied by increasing winter snowfall related to gradual intensification of the Siberian High from ca. 5000 to ca. 3000calyr BP. A thicker and more long-lasting snow cover can be assumed to have favoured P. pumila by providing a competitive advantage over other boreal and subalpine tree and shrub species in the region during the later part of the Holocene. These results, which are the first of their kind from Kamchatka, provide novel insight into the Holocene vegetational and climatic development in easternmost Asia, as well as long-term atmospheric circulation dynamics in Beringia.
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