| 1. |
- Wenzelberg, Charlotta, et al.
(författare)
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Svenska medicinstudenters tankar inför läkarexamen. Allmänmedicin och barn- och ungdomsmedicin lockar mest
- 2007
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Ingår i: Läkartidningen. - 0023-7205. ; 104:5, s. 322-325
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Tidskriftsartikel (refereegranskat)abstract
- In January 2005 all last-term medical students in Sweden were asked to complete a questionnaire about their future career. They were asked what three medical specialties they would like to work in after graduating, what specialty they would have chosen at the time of completing the questionnaire and if they would combine future clinical work with research and teaching. Information was obtained from 69 % of the students. The two medical specialties chosen by most students were general practice (17 %) and paediatrics (16 %). Significantly higher proportions of students wanting to work in these two specialties stated that they would also have chosen them, although most students (62 %) were uncertain about their choice regardless of specialty or gender. More than one third of the students (42 %) wished to combine future clinical work with research and teaching - an option however found to be far less popular among students preferring general practice to other specialties.
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| 2. |
- Dürango, Sofie, et al.
(författare)
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Compliance with guidelines for postoperative pain management in infants and children
- 2017
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Ingår i: International Journal of Healthcare Management. - : Informa UK Limited. - 2047-9700 .- 2047-9719. ; 10:4, s. 259-264
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Tidskriftsartikel (refereegranskat)abstract
- Background: Postoperative pain is still often being inadequately assessed and/or recorded in infants and young children despite evidence-based guidelines. Objectives: This prospective, observational study in a paediatric postoperative ward at a Swedish university hospital was designed to evaluate interventional effects on pain management by briefly reminding nursing staff of corresponding local guidelines. Methods: Individual structured postoperative information on the first day and night after mainly otorhinolaryngeal or plastic surgery was obtained in 100 pediatric patients from on-site bedside observation protocols, patient records, and telephone interviews over two 5-week periods before and after a study intervention with brief systematic information on local guideline contents. Results: The intervention was followed by significantly more assessments (P = 0.0012), hourly assessments (P < 0.0001), and use of validated tools for assessment (P < 0.0001) of pain intensity in out-hospital patients, but by no change in guardian satisfaction. There were non-significant corresponding changes in in-hospital patients. Conclusions: Bedside compliance with guidelines for postoperative pain management can be considerably improved in out-hospital (and possibly also in-hospital) paediatric patients by a structured brief reminder of existing guideline contents. Larger prospective studies are required to determine the importance of bedside compliance with clinical guidelines for postoperative comfort and safety in infants and children.
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| 3. |
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| 4. |
- Norin, Helena, et al.
(författare)
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Internal jugular dimensions and common carotid overlapping assessed in a cross-sectional study by ultrasonography at three neck levels in healthy volunteers
- 2017
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Ingår i: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 18:1, s. 69-72
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cannulation of the internal jugular vein may be associated with inadvertent puncture of the common carotid artery. Systematic use of ultrasound guidance has improved clinical success rates and reduced complications, but better knowledge of topographic relationships of the internal jugular vein and common carotid artery is desirable. This preclinical study was designed to determine by ultrasound technique relative topographic characteristics in humans of the internal jugular veins and common carotid arteries at different levels on both sides of the neck. Methods: One hundred and twenty healthy volunteers were examined bilaterally by ultrasound at three neck levels with and without contralateral rotation of the head. Twelve digital pictures were recorded and used to determine venous diameters and extents of arteriovenous overlapping in each subject. Results: Venous dimensions and arteriovenous overlapping were larger on the right side (p = 0.008) regardless of head rotation at all levels. There was more arteriovenous overlapping with than without rotation at right high- and mid-cervical levels (p<0.001). The only difference between right mid- and low-cervical levels was less arteriovenous overlapping at mid-cervical level without rotation (p = 0.017). The smallest venous dimensions and extent of arteriovenous overlapping were recorded at high-cervical level. Conclusions: Despite similar venous dimensions, less arteriovenous overlapping regardless of head rotation at mid-cervical level, together with the pleural proximity at low-cervical level, propose the internal jugular vein to be anatomically (other factors disregarded) favorable for vascular access on the right side, at mid-cervical level, close to the angle between the sternocleidomastoid muscle bellies, and with minimal rotation of the head.
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| 5. |
- Novak, Helene, et al.
(författare)
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Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children
- 2008
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Ingår i: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 18:1, s. 48-54
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital. Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge. Results: Ketamine and low-dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital. Conclusions: Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia.
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| 6. |
- Pikwer, Andreas, et al.
(författare)
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Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.
- 2010
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Ingår i: Journal of Vascular Access. - 1129-7298. ; 11, s. 323-328
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Objectives: This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization. Methods: Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively. Results: Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route. Conclusions: Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.
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| 7. |
- Krite Svanberg, Emilie, et al.
(författare)
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Physiological influence of basic perturbations assessed by non-invasive optical techniques in humans
- 2011
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Ingår i: Applied Physiology, Nutrition and Metabolism. - : Canadian Science Publishing. - 1715-5320 .- 1715-5312. ; 36:6, s. 946-957
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Tidskriftsartikel (refereegranskat)abstract
- New non-invasive techniques enabling frequent or continuous assessments of various pathophysiological conditions might be used to improve in-hospital outcome by enabling earlier and more reliable bedside detection of medical deterioration. In this preclinical study, three modern non-invasive optical techniques, laser Doppler imaging (LDI), near-infrared spectroscopy (NIRS), and tissue viability imaging (TVI), were all evaluated with respect to the influence of basic physiological perturbations (including local changes in arm positioning, skin temperature, and regional blood flow conditions) on quasi simultaneously obtained values of skin perfusion, muscle tissue oxygenation (StO2), and skin blood volume, recorded in eighteen healthy volunteers. Skin perfusion measured by LDI responded prominently to changes in positioning of the arm, whereas muscle StO2 measured by NIRS did not change significantly. Total haemoglobin count (HbT) measured by NIRS and blood volume estimated by TVI both increased significantly on lowering of the limb. On local cooling, the perfusion and blood volume were both found to increase considerably, while StO2 and HbT did not change. Local heating induced a more than 10-fold increase in skin perfusion and a small increase in blood volume. On progressive venoarterial occlusion, the perfusion, StO2, HbT, and blood volume values decreased, after transient increases in HbT and blood volume before full arterial occlusion occurred, and all values approached the baseline level on release of the occlusion with a slight overshoot of the StO2. The results obtained have potential bearing on future utilization of these non-invasive techniques in the management of severely injured and (or) critically ill patients.
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| 8. |
- Pikwer, Andreas, et al.
(författare)
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The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.
- 2008
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Ingår i: Anaesthesia and Intensive Care. - 0310-057X. ; 36:1, s. 30-37
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Tidskriftsartikel (refereegranskat)abstract
- Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.
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| 9. |
- Åkeson, Jonas, et al.
(författare)
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Aspiration av alifatiska kolväten kan ge livshotande lungpåverkan hos småbarn
- 1990
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Ingår i: Läkartidningen. - 0023-7205. ; 87:51-52, s. 4420-4423
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Tidskriftsartikel (refereegranskat)abstract
- Ingestion of aliphatic hydrocarbons--even in small amounts--can cause severe respiratory distress in children. Such accidents are becoming increasingly common in Sweden. A case of severe hydrocarbon ingestion is reported, where a 16-month-old boy, initially treated with mechanical ventilation for respiratory distress, subsequently developed a reversible radiological complication, pneumatocele. Patients at risk of severe hydrocarbon intoxication can be identified by careful evaluation of their history and continuous clinical observation. Controlled ventilation should be instituted early in respiratory distress, and any radiological changes followed up in a few weeks.
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| 10. |
- Adrian, Maria, et al.
(författare)
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Mechanical complications after central venous catheterisation in the ultrasound-guided era : a prospective multicentre cohort study
- 2022
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 1471-6771 .- 0007-0912. ; 129:6, s. 843-850
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Limited data are available on the incidence of mechanical complications after ultrasound-guided central venous catheterisation. We aimed to determine the incidence of mechanical complications in hospitals where real-time ultrasound guidance is clinical practice for central venous access and to identify variables associated with mechanical complications.METHODS: All central venous catheter insertions in patients ≥16 yr at four emergency care hospitals in Sweden from March 2, 2019 to December 31, 2020 were eligible for inclusion. Every insertion was monitored for complete documentation and occurrence of mechanical complications within 24 h after catheterisation. Multivariable logistic regression analyses were used to determine associations between predefined variables and mechanical complications.RESULTS: In total, 12 667 catheter insertions in 8586 patients were included. The incidence (95% confidence interval [CI]) of mechanical complications was 7.7% (7.3-8.2%), of which 0.4% (0.3-0.5%) were major complications. The multivariable analyses showed that patient BMI <20 kg m -2 (odds ratio 2.69 [95% CI: 1.17-5.62]), male operator gender (3.33 [1.60-7.38]), limited operator experience (3.11 [1.64-5.77]), and increasing number of skin punctures (2.18 [1.59-2.88]) were associated with major mechanical complication. Subclavian vein catheterisation was associated with pneumothorax (5.91 [2.13-17.26]). CONCLUSIONS: The incidence of major mechanical complications is low in hospitals where real-time ultrasound guidance is the standard of care for central venous access. Several variables independently associated with mechanical complications can be used for risk stratification before catheterisation procedures, which might further reduce complication rates.CLINICAL TRIAL REGISTRATION: NCT03782324.
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