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- 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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- Eriksson, Jacob, et al.
(författare)
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Finite Larmor radii effects in fast ion measurements as demonstrated using neutron emission spectrometry of JET plasmas heated with 3rd harmonic ICRF
- 2011
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Ingår i: 38th EPS Conference on Plasma Physics 2011 (EPS 2011): Europhysics Conference Abstracts. - 2914771681
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper demonstrates how the finite Larmor radii (FLR) of fast ions can affect fast ion measurements by studying data from the neutron time-of-flight spectrometer TOFOR. Neutron spectra were calculated from a model of the fast ion velocity distribution for a JET experiment with 3rd harmonic ICRF heating of deuterium beams. It was found that FLR effects need to be considered to get a good description of the data, if the Larmor radius of the fast ions are comparable to the width of the field of view of the instrument. This applies not only to results from neutron spectrometry but also to other types of fast ion diagnostics.
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- Hellström Ängerud, Karin, et al.
(författare)
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Differences in symptoms in relation to myocardial infarction.
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: In myocardial infarction (MI) rapid diagnosis and treatment is crucial for the prognosis. Previous research has found that symptom presentation influence pre hospital delay times but studies about differences in MI symptoms between patients with ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) are sparse and inconclusive. To enhance the understanding of symptom presentation in regard to MI type, we aimed to describe symptoms in relation to MI type and to find predictors of STEMI versus NSTEMI in patients with MI.Methods: Patients with MI (n=694) from the SymTime study were included. SymTime was a multicentre cross-sectional study of symptoms and actions in the prehospital phase of MI and data were collected using a previously validated questionnaire administered to MI patients within 24 h of admission to hospital.Results: Patients with STEMI were younger, more often men and smokers. Patients with NSTEMI were more likely to have a history of hypertension, MI and stroke. Chest pain was the most common symptom in both groups. Pain, discomfort, or pressure located in the jaw or teeth, vertigo/pre-syncope, cold sweat and nausea/vomiting were significantly more frequent in patients with STEMI (Table 1). In a multivariate logistic regression model patients with STEMI were more likely to present with cold sweat (OR 4.13, 95% CI 2.71–6.29) jaw pain (OR 2.14, 95% CI 1.02–4.50), and nausea (OR 2.01, 95% CI 1.20–3.33), and less likely to have a history of stroke (OR 0.35, 95% CI 0.15–0.84), fluctuating symptoms (OR 0.54, 95% CI 0.36–0.83) and anxiety (OR 0.54, 95% CI 0.32–0.92) compared to patients with NSTEMI.Conclusion: Patients with STEMI differed significantly from those with NSTEMI regarding symptom presentation. This knowledge is important for health care personnel to recognize symptoms alarming for STEMI when evaluating patients with MI symptoms.
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- Johansson, Maria, et al.
(författare)
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A close-up of human dimensions of wildlife in Europe
- 2016
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Konferensbidrag (refereegranskat)abstract
- In Europe an increasing number of scholars from different disciplines show growing interest in studying interactions between society and wildlife. Europe’s diversity with regard to cultures, languages and governance systems for wildlife is reflected in the wealth of research perspectives on human-wildlife interactions. Today a variety of approaches, disciplinary perspectives, theoretical frameworks, concepts and methods are used. However there is no common umbrella of “human dimensions of wildlife” similar to the one seen in North America.A network meeting was held with the goal to describe the current state of research in this field and to draft an outline for a future European research agenda. Sixty-three delegates from 25 European countries contributed due to workshop discussions and a follow-up online survey.Two major paths to the study of human-wildlife interactions were identified. One targets individuals or groups within society and is based on the theories of cognitive hierarchy and theory of reasoned action/theory of planned behavior. While the other focuses on the collective societal level relying mainly on the theories of governance with connections to social representation, deliberative procedures and commons theory. Europe’s diverse cultural contexts and governance systems may be a challenge for transnational research attempts but far more importantly they are an opportunity for learning. Therefore future research should strive for stringent theory-based research designs which can generate comparable data across countries as well as over time.
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- Prytz, Erik, et al.
(författare)
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Pilot evaluation of a persuasive mobile application to change individuals behavior during recurrent myocardial infarction
- 2019
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Ingår i: ECCE 2019, Proceedings of the 31st European Conference on Cognitive Ergonomics, ‘Design for Cognition'. - New York, NY, USA : Association for Computing Machinery (ACM). - 9781450371667 ; , s. 192-195
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Konferensbidrag (refereegranskat)abstract
- Objective: The objective of the current study was to develop and evaluate a persuasive decision-support aiming at reducing pre hospital delay and increasing ambulance service use for patients who suffer from a recurrent myocardial infarction. Materials and methods: The system was developed as a prototype mobile application for smartphones. The system was evaluated by four end-users with previous experience of myocardial infarction. The user tests were complemented with cognitive walkthroughs and heuristic evaluation. Results: A total of 14 persuasive design principles were used to guide the design of the system. The usability was regarded as high with an average score of 82 on the System Usability Scale. The users reported that they found the system highly persuasive. Conclusions: User-centered design together with persuasive design principles through iterative testing and development has resulted in a prototype app with potential to improve patients care seeking behavior. The content in the prototype will be further evaluated before it is integrated in educational interventions.
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- Roskvist, Maria, et al.
(författare)
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A national survey of pediatric tonsil surgery regarding pain management in Sweden
- 2023
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Konferensbidrag (refereegranskat)abstract
- Objectives: The primary aim of this study was to describe pain treatment in relation to surgery of the tonsils in Sweden. The secondary aim was to determine the impact of the provider’s regimens of analgesic treatment on the patient reported pain-related outcome measures (pain-PROMs) from National Tonsil surgery Register in Sweden (NTSRS).Methods: A descriptive cross-sectional study based on a web-questionary enrolled one respondent from 47 out of 48 invited ENT-clinics in Sweden. Pain-PROMs from the NTSRS were included.Results: Pre-emptive analgesia pre- and intraoperatively was paracetamol (100%), normally administered iv, and cox-inhibitors iv (74%). To prevent pain and nausea, betamethasone iv (92%/n=43) was administered. Paracetamol combined with cox-inhibitors (Ibuprofen) were recommended by all clinic as a basic analgesic regime postoperatively. The clinics usually prescribed (66%) higher dose of paracetamol day 1-3, followed by a reduced dose days 4-8. Additional rescue analgesics were prescribed after tonsillectomy to older children (62%/n=29), and to young children by 43%/n=20. The most common rescue analgesic was clonidine (55%), followed by oxicodon (34%), morphine (4%), and ketobemidone (2%). Pain-PROMs (NTSRS) showed the frequency of contacts with healthcare due to pain in children (15%). There was no significant difference in percentage of contacts due to pain regarding if clinics routinely prescribed rescue analgesics after tonsillectomy or not.Conclusions: The national analgesic regime after tonsil surgery is overall good. Despite this, there is a need for rise in awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the complexity of pain management after tonsil surgery.
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