| 1. |
- Bellner, Johan, et al.
(författare)
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Behov av handläggningsrutiner för lätt skallskadade patienter
- 1999
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Ingår i: Läkartidningen. - 0023-7205. ; 96:47, s. 5196-5198
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Tidskriftsartikel (refereegranskat)abstract
- Developing guidelines for quality assurance in the management of head injury requires knowledge concerning present management practice. We studied management of minor head injury (MHI) using a cross-sectional mail survey of 76 Swedish hospitals. In 96% of the hospitals, initial patient evaluation, frequently performed by inexperienced physicians, entails neurological assessment according to the Swedish Reaction Level Scale or the Glasgow Coma Scale, while computerised tomography (CT) is used routinely in 4%. This survey indicates great variability in the management of MHI in hospitals in Sweden. Fifteen (21%) hospitals consistently hospitalize all MHI patients for overnight observation, while 56 (79%) have established criteria for early discharge of selected patients. Routines for neurological assessment are satisfactory, while CT scan for skull fracture and early diagnosis of intracranial complications is usually not performed.
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| 2. |
- Bellner, Johan, et al.
(författare)
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Survey of the management of patients with minor head injuries in hospitals in Sweden
- 1999
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Ingår i: Acta Neurologica Scandinavica. - 1600-0404. ; 100:6, s. 355-359
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Development of guidelines for quality assurance in head injury care has to be based on knowledge about how today's management is organized. To address the need for guidelines in minor head injury (MHI), the authors studied management practice in Sweden. METHODS: We performed a cross-sectional mail survey including all 76 hospitals treating head-injured patients. The questionnaire outlined present management practice in MHI; including routines for clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up. RESULTS: The initial evaluation is frequently performed by inexperienced physicians. The level of consciousness is assessed according to the Swedish Reaction Level Scale or the Glasgow Coma Scale in 96% of the hospitals. Routine computerized tomography is used in 4%. Skull radiography is not routinely performed. Eighty percent of the hospitals discharge selected patients without in-hospital observation and most (93%) offer no routine follow-up. CONCLUSIONS: This survey shows a variation in the management of MHI in hospitals in Sweden. Routines for assessment of consciousness level are satisfactory, but CT scan for detection of skull fracture and early diagnoses of intracranial complications is usually not performed. Guidelines should be based on present routines including decision rules for CT scan.
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| 3. |
- Haukø, Anne-Marit, et al.
(författare)
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BRAVENT – Veileder for brannteknisk prosjektering av ventilasjonsanlegg i skolebygg
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Dette dokumentet er en veileder. Veilederen skal benyttes av rådgivende ingeniører i brannteknisk prosjektering av ventilasjonsanlegg i skolebygg. Det fokuseres på rømningssikkerhet og skadebegrensning ved små branner i en tidlig fase av brannforløpet. Veilederen beskriver forutsetninger for bruk, krav og preaksepterte ytelser i VTEK, samt ulike typer ventilasjonsanlegg med tilhørende komponenter. Dokumentet illustrerer typiske prinsippløsninger for ulike ventilasjonsstrategier i bygg, samt forskningsresultater fra brannforsøk og undersøkelser i tidligere faser av BRAVENT-prosjektet. Veilederen tar for seg nybygg, eksisterende bygg og verneverdige bygg hvor grensesnittet mellom rådgivende ingeniør brann (RIBr), ventilasjon (RIV), elektro (RIE) og automasjon (RIAut) defineres. En sjekkliste oppsummerer viktige punkter å hensynta ved prosjektering av ventilasjonsanlegg. Rutiner for drift og vedlikehold beskrives til slutt.
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| 4. |
- Haukø, Anne-Marit, et al.
(författare)
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Prosjektnotat : Kontrollplan – Ventilasjonsanleggets funksjon under brann
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Dette notatet er en delleveranse i arbeidspakke WP3 i prosjektet BRAVENT – Effektiv ventilasjon av røyk fra små branner. Notatet med tilhørende vedlegg Kontrollplan gir en beskrivelse av hvordan periodisk kontroll og daglig/ukentlig internkontroll av ventilasjonsanleggets funksjon under brann i skolebygg kan utføres. Kontrollplanen kan også være nyttig for bruk i andre offentlige formålsbygg.
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| 5. |
- Muller, Kay, et al.
(författare)
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Analysis of protein S-100B in serum: a methodological study
- 2006
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Ingår i: Clinical Chemistry and Laboratory Medicine. - 1434-6621. ; 44:9, s. 1111-1114
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dysfunction and damage of the human central nervous system can be detected with biochemical markers, and protein S-100B is the best-established such marker. The aim of this study was to evaluate whether the protein is stable during longterm storage, to establish reference values for the new Elecsys((R)) S100 test and to compare this new method with the Liaison((R)) Sangtec((R)) 100 test. Methods: We analysed blood samples from 118 blood donors and 196 patients with subarachnoid haemorrhage or head injury. The long-term stability of S-100B in frozen serum samples was evaluated with repeated analysis in 1997 and 2003 using an immunoradiometric assay. Method comparison between the Liaison((R)) Sangtec((R)) 100 and Elecsys((R)) S100 tests was performed using Bland-Altman difference plots. Results: Serum concentrations increased significantly during long-term storage (mean difference 0.15 mu g/L; +/- 2 SD, 0.55 mu g/L). Serum measurements using the Elecsys ((R)) S100 method in 118 healthy blood donors showed S-100B levels between 0.02 and 0.08 mu g/L (mean 0.05). The 95th percentile was 0.07 mu g/L. The Liaison ((R)) Sangtec((R)) 100 test usually measured higher concentrations than the Elecsys((R)) S100 method, and the difference between the two methods increased with increasing concentrations. The mean difference between the methods was 0.14 mu g/L (+/- 2 SD, 0.39 mu g/L). Conclusions: Protein S-100B is not stable during longterm storage and the two analytical methods are not interchangeable.
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| 6. |
- Muller, Kay, et al.
(författare)
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S100B serum level predicts computed tomography findings after minor head injury
- 2007
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Ingår i: Journal of Trauma. - 0022-5282. ; 62:6, s. 1452-1456
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mild head injury (MHI) implies a risk for traumatic brain injury and even a small risk for development of an intracranial hematoma. Head computed tomography (CT) is recommended for early detection of such pathologic findings. The present multicenter study was performed to investigate whether determination of protein S100B in serum could contribute to the selection of patients for CT scanning. Methods: We included 226 patients with a history of head injury and a Glasgow Coma Scale (GCS) score of 13 to 15 at admission to hospital. Blood samples for S100B analysis and head CT were obtained within 12 hours after the injury. The diagnostic properties of S100B measurements for prediction of intracranial injury revealed by CT were tested with receiver operating characteristic (ROC) analysis and cross-table analysis at different cut-off levels. We also included analysis of S100B levels normalized to correspond to blood sampling I hour after the injury. Results: CT showed intracranial injury in 21 (9.3%) patients. S100B levels were significantly (p < 0.001) elevated in patients with intracranial injury (mean, 0.36; 95% CI, 0.21-0.50 mu g/L) compared with those in patients without intracranial injury (mean, 0.18; 95% CI, 0.16-0.20 mu g/L). ROC curve analysis showed a significant (p = 0.001) area under the curve (0.73; 95% CI, 0.62-0.84). Cross-table analysis showed that 20 of 21 (sensitivity 0.95) patients with intracranial injury were detected at a cut-off level of 0.10 mu g/L, but 141 of 205 (specificity 0.31) patients with no such injury also had a S100B level above this limit. Exclusion of cases with blood samples collected more than 3 hours after injury or normalization did not improve the diagnostic properties. Conclusion: Determination of serum S100B cannot replace the clinical examination or use of CT for patients with minor head injury, but adding S100B measurement to the clinical evaluation might support selection of patients for CT scanning.
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| 7. |
- Sjåvik, Kristin, et al.
(författare)
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Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin
- 2016
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 88, s. 320-326
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Tidskriftsartikel (refereegranskat)abstract
- Object: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated. The current study aimed to clarify the risk-benefit of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma. METHODS: In a Scandinavian population-based cohort we conducted a retrospective review of 979 operations for intracranial meningioma between 2007 and 2013 at three neurosurgical centers with population-based referral. We compared two different treatment strategies analyzing frequencies of VTE and proportions of postoperative intracranial hematomas requiring surgery or intensified subsequent observation or care (ICU or other intensified observation and/or treatment). One neurosurgical center favored preoperative prophylaxis with low-molecular weight heparin (LMWH) ("LMWH routine group") in addition to mechanical prophylaxis, while two centers favored mechanical prophylaxis with LMWH only given as needed in cases of delayed mobilization ("LMWH as needed group"). RESULTS: In the LMWH routine group, VTE was diagnosed after 24/626 operations (3.9%), while VTE was diagnosed after 11/353 (3.1%) operations in the LMWH as needed group (p=0.56). Clinically relevant postoperative hematomas occurred after 57/626 operations (9.1%) in the LMWH routine group compared to 23/353 (6.5%) in the LMWH as needed group (p=0.16). Surgically evacuated postoperative hematomas occurred after 19/626 operations (3.0%) in the LMWH routine group compared to 8/353 operations (2.3%) in the LMWH as needed group (p=0.26). CONCLUSION: There is no benefit of routine preoperative LMWH starting before intracranial meningioma surgery. Neither could we for primary outcomes detect a significant increase in clinically relevant postoperative hematomas secondary to this regimen. We suggest that "as-needed" perioperative administration of LMWH, reserved for patients with excess risk due to delayed mobilization, is effective and also appears to be the safest strategy.
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| 8. |
- Unden, Johan, et al.
(författare)
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Clinical significance of serum S100B levels in neurointensive care
- 2007
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Ingår i: Neurocritical Care. - : Springer Science and Business Media LLC. - 1541-6933 .- 1556-0961. ; 6:2, s. 94-99
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Tidskriftsartikel (refereegranskat)abstract
- Objective S100B is viewed as the most promising biomarker for brain damage. It has been proposed that this marker is useful in a Neurointensive Care Unit (NICU) as a monitoring parameter. This study aims to examine the clinical usefulness of daily serum S100B measurements in this setting. Design Prospective consecutive inclusion of patients. Patients A total of 79 patients with confirmed or suspected head injury or cerebrovascular insults (CVIs) (based upon patient history, computed tomography (CT) and/or magnetic resonance imaging (MRI) and neurological examination including coma scoring) who required neurointensive care were included in the study. Interventions Sampling for S100B was performed at admission and daily until patients were discharged from the NICU. S100B measurements were statistically compared to occurrence of secondary complications and outcome according to Glasgow Outcome Scale (GOS), with focus on clinical prediction. Measurements and main results 17 of 79 patients (22%) had secondary neurological complications. Mean S100B levels were found to be an independent parameter associated with these complications (P = 0.03). Mean S100B levels were higher in patients with complications compared to those without on both the complication day (P = 0.033) and the day after (P = 0.015), but not the day prior to the complication (P = 0.62). S100B did not predict secondary neurological complication. Neither mean (P = 0.182) nor peak (P = 0.370) S100B levels were associated with or predicted outcome according to dichotornised GOS. Conclusion Daily S100B measurements are associated with secondary complications but not to outcome. However, daily S100B levels do not predict secondary complications, which limit the usefulness of this brain biomarker in this setting.
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