| 1. |
- Bergkvist, Anna, et al.
(författare)
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A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management
- 2009
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Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley. - 1365-2753 .- 1356-1294. ; 15:4, s. 660-667
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives To evaluate if an integrated medicines management can lead to a more appropriate drug use in elderly inpatients. Method The study was an intervention study at a department of internal medicine in southern Sweden. During the intervention period pharmacists took part in the daily work at the wards. Systematic interventions aiming to identify, solve and prevent drug-related problems (DRPs) were performed during the patient's hospital stay by multidisciplinary teams consisting of physicians, nurses and pharmacists. DRPs identified by the pharmacist were put forward to the care team and discussed. Medication Appropriateness Index (MAI) was used to evaluate the appropriateness in the patients' drug treatment at admission, discharge and 2 weeks after discharge. In total 43 patients were included, 28 patients in the intervention group and 25 patients in the group which was used as control. Results For the intervention group there was a significant decrease in the number of inappropriate drugs compared with the control group (P = 0.049). Indication, duration and expenses were the MAI-dimensions with most inappropriate ratings, and the drugs with most inappropriate ratings were anxiolytics, hypnotics and sedatives. Conclusion This kind of systematic approach on drug therapy can result in a more appropriate drug use in the elderly.
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| 2. |
- Bergkvist, Anna, et al.
(författare)
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Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
- 2009
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 1037-1046
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.
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| 3. |
- Bergkvist, Anna, et al.
(författare)
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The process of identifying, solving and preventing drug related problems in the LIMM-study
- 2011
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 33:6, s. 1010-1018
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Tidskriftsartikel (refereegranskat)abstract
- Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient's drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service. Setting Three wards at a department of internal medicine. Method Pharmacists performed systematic interventions during the patient's hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel's attitudes towards the process. Main outcome measure The number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel's attitudes towards the model. Results In total, 1,227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. Conclusion The process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance.
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| 4. |
- Bergkvist, Tommy, et al.
(författare)
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Effects of ICRH on the dynamics of fast particle excited alfven eigenmodes
- 2007
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Ingår i: Radio Frequency Power in Plasmas. - : American Institute of Physics (AIP). - 9780735404441 - 0735404445 ; , s. 455-458
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Konferensbidrag (refereegranskat)abstract
- ICRH is often used in experiments to simulate destabilization of Alfvén eigenmodes by thermonuclear α-particles. Whereas the slowing down distribution of α-particles is nearly isotropic, the ICRH creates an anisotropic distribution function with non-standard orbits. The ICRH does not only build up gradients in phase space, which destabilizes the AEs, but it also provides a strong phase decorrelation mechanism between ions and AEs. Renewal of the distribution function by thermonuclear reactions and losses of α-particles to the wall lead to a continuous drive of the AEs. Simulations of the non-linear dynamics of AEs and the impact they have on the heating profile due to particle redistribution are presented.
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| 5. |
- Bergkvist, Tommy, et al.
(författare)
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Non-linear Alfvén eigenmode dynamics of a burning plasma in the presence of ion cyclotron resonance heating
- 2006
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Ingår i: EPS Conf. Plasma Phys., EPS. - 9781622763337 ; , s. 1792-1795
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Konferensbidrag (refereegranskat)abstract
- Alfvén eigenmodes (AEs) excited by α particles in a burning plasma can degrade the heating efficiency by spatial redistribution of the resonant α particles. Changes of the orbit invariants in phase space by collisions and other waves, such as magnetosonic waves during ion cyclotron resonance heating (ICRH), lead to changes in the phase between the αs and AEs, causing a decorrelation of the interactions. ICRH lead to an increased decorrelation of the AE interactions and hence a stronger radial redistribution of the thermonuclear α particles by the AEs. Renewal of the distribution function by thermonuclear reactions and losses of α particles to the wall lead to a continuous drive of the AEs and a radial redistribution of the α particles. The redistribution results in a degradation of the heating efficiency.
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| 6. |
- Bergkvist, Tommy, 1975-
(författare)
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Non-linear dynamics of Alfvén eigenmodes excited by fast ions in tokamaks
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The tokamak is so far the most promising magnetic configuration for achieving a net production of fusion energy. The D-T fusion reactions result in 3.5 MeV alpha-particles, which may destabilize Alfvén eigenmodes through wave-particle interaction. These instabilities redistribute the alpha-particles from the central region of the plasma towards the edge, where they are thermalized, and hence result in a reduced heating efficiency. The high-energy alpha-particles may even be thrown out of the plasma and may damage the wall. To investigate the destabilization of Alfvén eigenmodes by high-energy ions, ion cyclotron resonance heating (ICRH) and neutral beam injection (NBI) are often used to create a high-energy tail on the distribution function. The ICRH does not only produce high-energy anisotropic tails, it also decorrelates the wave-particle interaction with the Alfvén eigenmodes. Without decorrelation of the wave-particle interaction an ion will undergo a superadiabatic oscillation in phase space and there will be no net transfer of energy to the mode. For the thermal ions the decorrelation from collisions dominates while for the high-energy ions the decorrelation from ICRH dominates. As the unstable modes grow up, the gradients in phase space, which drive the mode, are reduced, resulting in a weaker drive. The dynamics of the system becomes non-linear due to a continuous restoration of the gradients by D-T reactions and ICRH. In this thesis the non-linear dynamics of toroidal Alfvén eigenmodes (TAEs) during ICRH has been investigated using the SELFO code. The SELFO code, which calculates the distribution function during ICRH self-consistently using a Monte-Carlo metod, has been upgraded to include interactions with TAEs. The fast decay of the mode amplitude as the ICRH is switched off, which is seen in experiments, as well as the oscillation of the mode amplitude as the distribution function is repetetively built up by the ICRH and flattened by the TAE has been reproduced using numerical simulations. In the presence of several unstable modes the dynamics become more complicated. The redistribution of an alpha-particle slowing down distribution function as well as the reduced heating efficiency in the presence of several modes has also been investigated.
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| 7. |
- Bergkvist, Tommy, et al.
(författare)
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Non-linear dynamics of Alfvén eigenmodes excited by thermonulcear alpha particles in the presence of ion cyclotron resonance heating
- 2007
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 47:9, s. 1131-1141
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Tidskriftsartikel (refereegranskat)abstract
- Alfvén eigenmodes (AEs) excited by thermonuclear α-particles can degrade the heating efficiency by spatial redistribution of the resonant α-particles. Changes of the orbit invariants in phase space by collisions and interactions with other waves, such as magnetosonic waves during ion cyclotron resonance heating (ICRH), lead to changes in the phase between the α-particles and AEs, causing a decorrelation of the interactions and stronger redistribution of the α-particles. Cyclotron interactions increase the decorrelation of the AE interactions with the high-energy ions and hence a stronger radial redistribution of the high-energy α-particles by the AEs. Renewal of the distribution function by thermonuclear reactions and losses of α-particles to the wall lead to a continuous drive of the AEs and a radial redistribution of the α-particles. The condition for excitation of AEs is shown to depend on the heating scenario where heating at the low field side creates a significant population of high-energy non-standard orbits which drive the modes. The redistribution results in a reduction in the averaged α-particle energy and a degradation of the heating efficiency. The effect on the distribution function in the presence of several unstable modes is not additive and the particle redistribution is found to saturate with an increasing number of modes.
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| 8. |
- Bergkvist, Tommy, et al.
(författare)
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Non-linear study of fast particle excitation of global Alfvén eigenmodes during ICRH
- 2005
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 45, s. 485-493
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Tidskriftsartikel (refereegranskat)abstract
- High-power ion–cyclotron resonance heating (ICRH) can produce centrally peaked fast ion distributions with wide non-standard drift orbits exciting Alfvén eigenmodes (AEs). The dynamics of the AE excitation depends not only on the anisotropy and the peaking of the fast ion distribution but also on the decorrelation of the AE interactions and the renewal of the fast ions resonant with the AE by ion–cyclotron interactions. A method of self-consistently including the evolution of the distribution function of fast ions during excitation of AEs and ICRH has been developed and implemented in the SELFO code. Numerical simulations of the AE dynamics and ICRH give a variation of the AE amplitude consistent with the experimentally observed splitting of the mode frequency. The experimentally observed fast damping of the mode as the ICRH is switched off is also evident in the simulations.
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| 9. |
- Bergkvist, Tommy, et al.
(författare)
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Nonlinear interaction between RF-heated high-energy ions and MHD-modes
- 2003
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Ingår i: RADIO FREQUENCY POWER IN PLASMAS. - 0735401586 ; , s. 459-462
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Konferensbidrag (refereegranskat)abstract
- Excitation of global Alfven eigenmodes by fast ions during ICRH is frequently observed in tokamaks. The importance of the phasing of the ICRH antennae for the excitation of these modes have been seen in experiments. The Alfven eigenmodes will drive the distribution function of the fast ions towards a state where the gradient in phase space is reduced. In general, the fast ions are displaced outwards, which can have a significant effect on the ICRH power deposition and lead to reduced heating efficiency. To calculate the effect on the heating profiles by the excitation of Alfven eigenmodes and the, effect on the resonating ions the Monte Carlo code FIDO, used for ICRH, has been upgraded to include particle interactions with MHD-waves. This allows self-consistent calculations of the mode amplitude and the distribution function during RF heating.
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| 10. |
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