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1181.
  • Wåhlin, Ingrid, et al. (författare)
  • What do patients rate as most important when cared for in the ICU and how often is this met? an empowerment questionnaire survey
  • 2017
  • Ingår i: Journal of critical care. - Elsevier. - 0883-9441. ; 40, s. 83-90
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to explore what patients rate as being of the greatest importance and less important, when being cared for in the intensive care unit (ICU). The aim was also to examine the extent to which these topics are met.In the Patient Empowerment Questionnaire (PEQ-ICU), patients were first asked to rate the importance of 28 items, and then how often those topics were met during their stay in the ICU.  Having trust/confidence in staff, Receive visits from next of kin, Staff being positive to visitors, Receive pain relief, Staff showing human warmth, and Staff trying to strengthen my life spirit were the items that most patients evaluated as being of the greatest importance. The items Staff being positive to visitors, Receiving pain relief and Receive visits from next of kin, were the items most frequently considered as “always met”, while the items Have influence and Receive help to look forward were less often met.It was found that there is a potential for improvement in helping the ICU patients to maintain contact with reality, remind them about their importance to someone or something, and what they could look forward to when becoming healthier and returning to ordinary life.HighlightsRelationships and caring atmosphere were considered to be of greater importance than physical help and support.Get visits from next of kin was found to be the second most important topic to ICU patients, after Have trust in staff.ICU patients need help to get their life spirit strengthen e.g. by being reminded about what they could look forward to.
1182.
  • Wändell, Per, et al. (författare)
  • The association between relevant comorbidities and dementia in patients with atrial fibrillation
  • 2018
  • Ingår i: GeroScience. - Springer. - 2509-2715. ; 40:3, s. 317-324
  • Tidskriftsartikel (refereegranskat)abstract
    • Risk of dementia is increased in patients with atrial fibrillation (AF). We aimed to study associations between relevant comorbidities and prevalent as well as incident dementia in AF patients. Study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centers in Sweden 2001–2007. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for associations between comorbidities and prevalent dementia. In a subsample (n = 12,096), (excluding patients with dementia diagnosed before AF onset), Cox regression was used to estimate hazard ratios (HR) with 95% CIs for association between comorbidities, and incident dementia, after adjustment for age, socioeconomic factors and anticoagulant treatment. Totally 937 patients (7.6%), 388 men (5.8%) and 549 women (9.7%), were diagnosed with dementia. After adjustments, prevalent dementia was more common in (ORs, 95% CI) men with congestive heart failure (CHF), stroke, and depression; in women with CHF and depression, and among women > 75 years with stroke, but less common in women with hypertension. During a 5.6-year follow-up (standard deviation 2.5), 750 patients (6.2%; 322 men, 4.9%, and 428 women, 7.8%) were diagnosed with incident dementia. An increased risk of incident dementia was found among men with diabetes and depression; a decreased risk among men and women with CHF, and among women with hypertension, myocardial infarction cerebrovascular diseases. The findings regarding incident dementia need to be interpreted with great caution, as they may have been subject to survival bias.
1183.
  • Wändell, Per, et al. (författare)
  • Urolithiasis in immigrant groups : : a nationwide cohort study in Sweden
  • 2019
  • Ingår i: Scandinavian Journal of Urology. - Taylor & Francis. - 2168-1805. ; 53:1, s. 69-76
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the association between country of birth and incident urolithiasis in immigrant groups in Sweden, using individuals born in Sweden (or with Swedish-born parents in the second-generation study) as referents. Methods: This nationwide follow-up study included first- and second-generation immigrants residing in Sweden between 1 January 1998 and 31 December 2012. Urolithiasis was defined as having at least one registered diagnosis of urolithiasis in the National Patient Register. Cox regression analysis was used to estimate the risk (hazard ratios (HR) with 95% confidence intervals (CI)) of incident urolithiasis. The models were stratified by sex and adjusted for age, sociodemographic status and co-morbidity. Results: Compared to referents, slightly higher incidence rates and HRs of urolithiasis (HR; 95% CI) were observed among first-generation men (1.06; 1.04–1.09) and women (1.12; 1.08–1.16) but not among second-generation immigrants (persons born in Sweden with foreign-born parents). Among first-generation immigrants, higher HRs were noted among men and women from Central and Eastern Europe, Russia, Latin America, Africa and Asia. Lower HRs were seen among men and women from the Nordic countries, most Western European countries and North America. Among second-generation immigrants, higher HRs were noted among men and women from Denmark, Germany and Hungary, in men from Austria, and in women from the Netherlands and Poland. Lower HRs were seen in second generation immigrants from Latin America, Africa and Asia (men and women). Conclusions: We observed substantial differences in incidence of urolithiasis between certain immigrant groups and the Swedish-born population, of importance in the clinical situation.
1184.
  • Xaplanteris, P., et al. (författare)
  • Five-Year Outcomes with PCI Guided by Fractional Flow Reserve
  • 2018
  • Ingår i: New England Journal of Medicine. - Massachussetts Medical Society. - 0028-4793. ; 379:3, s. 250-259
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease.METHODS: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, <= 0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization.RESULTS: A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval (CIS, 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy.CONCLUSIONS: In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone.
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1185.
  • Yamada, Tomohide, et al. (författare)
  • Successfully achieving target weight loss influences subsequent maintenance of lower weight and dropout from treatment
  • 2015
  • Ingår i: Obesity Research. - Nature Publishing Group. - 1930-739X. ; 23:1, s. 91-183
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The influence of the amount and rate of weight loss on subsequently regaining weight and dropout from treatment in severely obese patients targeting 5% weight loss was investigated.METHODS: A total of 120 consecutive hospital patients with severe obesity (BMI: 42 ± 9 kg/m(2) ) participated in an inpatient program targeting 5% weight loss that involved goal setting, charting weight four times daily, and diet and exercise. They were followed after discharge to assess subsequent regaining of weight and dropout.RESULTS: Mean weight loss was 4.9 ± 2.4% after a mean of 19 days in the hospital, and 43% of the patients achieved the target weight loss (>5%). Over the median 2-year follow-up period, greater than 5% in-hospital weight loss was associated with a significantly lower risk of regaining weight after adjustment for various factors (>5% to ≤7% loss: hazard ratio 0.30 [0.11-0.85] for regaining all of the lost weight and 0.32 [0.13-0.78] for regaining half of the lost weight). No significant relation between the amount or rate of weight loss and dropout from subsequent outpatient treatment was seen.CONCLUSIONS: Successfully achieving the target weight loss in a comprehensive program predicts subsequent maintenance of lower weight without increasing the risk of dropout. Successful in-hospital weight loss might increase the motivation of obese patients.
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1186.
  • Yang, Runkuan, et al. (författare)
  • HMGB1 and Histones Play a Significant Role in Inducing Systemic Inflammation and Multiple Organ Dysfunctions in Severe Acute Pancreatitis
  • 2017
  • Ingår i: INTERNATIONAL JOURNAL OF INFLAMMATION. - HINDAWI LTD. - 2090-8040.
  • Forskningsöversikt (övrigt vetenskapligt)abstract
    • Severe acute pancreatitis (SAP) starts as a local inflammation of pancreatic tissue that induces the development of multiple extrapancreatic organs dysfunction; however, the underlying mechanisms are still not clear. Ischemia-reperfusion, circulating inflammatory cytokines, and possible bile cytokines significantly contribute to gut mucosal injury and intestinal bacterial translocation (BT) during SAP. Circulating HMGB1 level is significantly increased in SAP patients and HMGB1 is an important factor that mediates (at least partly) gut BT during SAP. Gut BT plays a critical role in triggering/inducing systemic inflammation/sepsis in critical illness, and profound systemic inflammatory response syndrome (SIRS) can lead to multiple organ dysfunction syndrome (MODS) during SAP, and systemic inflammation with multiorgan dysfunction is the cause of death in experimental SAP. Therefore, HMGB1 is an important factor that links gut BT and systemic inflammation. Furthermore, HMGB1 significantly contributes to multiple organ injuries. The SAP patients also have significantly increased circulating histones and cell-free DNAs levels, which can reflect the disease severity and contribute to multiple organ injuries in SAP. Hepatic Kupffer cells (KCs) are the predominant source of circulating inflammatory cytokines in SAP, and new evidence indicates that hepatocyte is another important source of circulating HMGB1 in SAP; therefore, treating the liver injury is important in SAP.
1187.
  • Zeng, Veronica Y., et al. (författare)
  • Impact of nocturia on patients health-related quality of life and healthcare resource utilisation compared with OAB and BPH Results from an observational survey in European and American patients
  • ????
  • Ingår i: International journal of clinical practice (Esher). - Wiley-Blackwell Publishing Inc.. - 1368-5031.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To evaluate the impact of nocturia on patients quality of life and healthcare resource utilisation (HRU) compared with overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Methods Data were drawn from a multinational (France, Germany, Spain, UK and US) survey of physician and patient-reported outcomes. The patient groups of interests were those diagnosed with only nocturia, with only OAB, and with only BPH. Health-related quality of life (HRQoL) and productivity measures were derived from the EuroQoL-5D, OAB-q and the Work Productivity and Activity Impairment Questionnaire (WPAI). Measures of HRU included lower urinary tract symptoms (LUTS)-relevant surgeries, hospitalisations, current use of pads and related physician visits. Bivariate and multivariate regression analyses were used to evaluate associations between HRQoL/HRU/Productivity and nocturia status. Multivariate analysis was used to address any potential confounding factors among the groups, ie age, gender, body mass index (BMI), ethnicity and comorbidities. Results A total of 3552 patients were identified including 358 nocturia patients, 1415 OAB patients and 1779 BPH patients. The mean age of the nocturia patients was 61.2 years with a mean BMI of 27.3. About 60.6% were women, 87.2% were Caucasian, and their most common comorbidities included depression, hypertension and diabetes. In terms of impact, nocturia patients were significantly worse off than OAB patients in their HRQoL. There was no significant difference regarding HRU and productivity measurement. Nocturia patients also presented with significantly worse HRQoL and lower productivity compared with BPH patients. Nocturia patients also had more physician visits. Conclusions Nocturia should be emphasised as a standalone LUTS disease with substantial patient impact. Compared with OAB and/or BPH, nocturia patients presented with a significant reduction on patients quality of life, reduced work productivity and increased utilisation of healthcare resources.
1188.
  • Zenténius, Edit, et al. (författare)
  • Self-Reported Weight-Loss Methods and Weight Change: Ten-Year Analysis in the Swedish Obese Subjects Study Control Group
  • 2018
  • Ingår i: Obesity. - 1930-7381. ; 26:7, s. 1137-1143
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveThe Swedish Obese Subjects (SOS) study was designed to compare outcomes in patients with obesity treated by bariatric surgery and a matched control group given usual care. The aim of this study was to analyze self-reported weight-loss methods and weight changes over 10 years in the SOS control group. MethodsSelf-reported weight-loss methods in the control group (n=2,037; 71% women; 48.76.3 years; BMI 40.14.7 kg/m(2)) were analyzed at baseline and after 0.5, 1, 2, 3, 4, 6, 8, and 10 years of follow-up and studied in relation to weight changes. ResultsThe average 10-year weight change was +2.1% (95% CI: 1.4%-2.8%). At every follow-up, 82.7% (95% CI: 81.3%-84.1%) of participants reported weight-loss attempts. At 10 years, 12.5% of the participants had10% weight loss and 22.3% had10% weight gain. Participants who lost or gained weight reported similar usage of weight-loss methods. ConclusionsOver 10 years, the majority of the participants of the SOS control group reported continuous efforts to lose weight. These results illustrate the constant struggle individuals with severe obesity are facing and that, on average, the results of long-term weight loss and weight maintenance were discouraging.
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1189.
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1190.
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