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- Svensson, Peter, et al.
(författare)
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Multidisciplinär kurs i akutmedicin ger ST-läkare större säkerhet
- 2002
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Ingår i: Läkartidningen. - 0023-7205. ; 99:45, s. 4490-4490
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Tidskriftsartikel (refereegranskat)abstract
- Lack of courses in emergency medicine for doctors under training is currently a problem in Sweden. Only 10 percent will have these courses early under their internship. The University hospital in Malmoe has therefore decided to create a course for doctors under training and to offer it early in their education. The curriculum is based on a problem-based learning concept using a modified case methodology that has been used since the 1920's at Harvard Business school in Boston. The course integrates doctors from different specialties with experienced nurses from the emergency ward. The five day course comprises; three theoretical days where cases from the emergency room are discussed with the case methodology, followed by two days of practical training. Our results from 100 participants over a period of two years is very encouraging, over 85 percent of the participants were very satisfied with the course. The multidisciplinary discussion about different cases was much appreciated. Our experience of this problem-based learning concept is very good, since it promotes deep rather than surface learning and promotes an in-depth collaboration between disciplines.
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| 4. |
- Alsved, Malin, et al.
(författare)
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Sources of Airborne Norovirus in Hospital Outbreaks
- 2020
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Ingår i: Clinical Infectious Diseases. - : Oxford University Press (OUP). - 1537-6591 .- 1058-4838. ; 70:10, s. 2023-2028
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Noroviruses are the major cause of viral gastroenteritis. Disease transmission is difficult to prevent and outbreaks in healthcare facilities commonly occur. Contact with infected persons and contaminated environments are believed to be the main routes of transmission. However, noroviruses have recently been found in aerosols and airborne transmission has been suggested. The aim of our study was to investigate associations between symptoms of gastroenteritis and presence of airborne norovirus, and to investigate the size of norovirus carrying particles.METHODS: Air sampling was repeatedly performed close to 26 patients with norovirus infections. Samples were analysed for norovirus RNA by RT-qPCR. The times since the patients' last episodes of vomiting and diarrhoea were recorded. Size separating aerosol particle collection was also performed in ward corridors.RESULTS: Norovirus RNA was found in 21 (24%) of 86 air samples from 10 different patients. Only air samples during outbreaks, or before a succeeding outbreak, tested positive for norovirus RNA. Airborne norovirus RNA was also strongly associated with a shorter time period since the last vomiting episode (odds ratio 8.1, p=0.04 within 3 hours since the last vomiting episode). The concentration of airborne norovirus ranged from 5-215 copies/m3, and detectable amounts of norovirus RNA were found in particles <0.95 µm and >4.51 µm.CONCLUSIONS: The results suggest that recent vomiting is the major source of airborne norovirus and imply a connection between airborne norovirus and outbreaks. The presence of norovirus RNA in submicrometre particles indicates that airborne transmission can be an important transmission route.
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| 5. |
- Bjorkander, J, et al.
(författare)
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Prospective open-label study of pharmacokinetics, efficacy and safety of a new 10% liquid intravenous immunoglobulin in patients with hypo- or agammaglobulinemia
- 2006
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Ingår i: Vox Sanguinis. - : Wiley. - 1423-0410 .- 0042-9007. ; 90:4, s. 286-293
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives The aim of this study was to evaluate the pharmacokinetics, efficacy and safety of a newly developed 10% liquid immunoglobulin preparation in patients with primary immunodeficiency diseases. This new preparation for intravenous use includes three dedicated virus clearance steps in its manufacturing process to ensure a high margin of viral safety. Materials and Methods This was a prospective, open-label, non-controlled, multicentre study. Twenty-two subjects with primary immunodeficiency were treated initially with three infusions of a licensed intravenous immunoglobulin to standardize the immunoglobulin G (IgG) replacement therapy of all subjects to the same intravenous product. A total of nine infusions of the new 10% liquid preparation were subsequently administered. Results The median terminal half-life of total IgG following administration of the new preparation was 30.1 days. Median terminal half-lives for IgG subclasses IgG(1), IgG(2), IgG(3) and IgG(4) were 28.3, 31.3, 20.9 and 24.2 days, respectively. The median total serum IgG steady-state trough level was 8.51 g/l. No severe infection episodes started after initiation of treatment with the new preparation. The median rate of mild or moderate infection episodes was 0.48 per month. A total of 194 infusions with the new 10% liquid immunoglobulin preparation were administered. The mean dose per infusion was 0.41 g/kg body weight and the maximum infusion rates recorded were 8 ml/kg/h. Adverse experiences were mostly mild and unrelated to the study drugs. Only 4% of infusions with the new product were followed by one or more related adverse experiences. Conclusion The new 10% liquid immunoglobulin preparation was well tolerated and shown to have an excellent pharmacokinetic, efficacy and safety profile. The liquid formulation provides convenience to patients and healthcare professionals.
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| 6. |
- Holmdahl, Torsten, et al.
(författare)
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A Head-to-Head Comparison of Hydrogen Peroxide Vapor and Aerosol Room Decontamination Systems.
- 2011
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Ingår i: Infection Control & Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 32:9, s. 831-836
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Tidskriftsartikel (refereegranskat)abstract
- Objective. New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide-based area decontamination technologies on the market, but no head-to-head studies have been performed. Design. We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HPV) system (Bioquell) and an aerosolized hydrogen peroxide (aHP) system (Sterinis). Setting. The tests were conducted in a purpose-built 136-m(3) test room. Methods. One HPV generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched Geobacillus stearothermophilus biological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system. Results. All BIs were inactivated for the 3 HPV tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HPV and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HPV tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage. Conclusion. One HPV generator was more effective than 2 aHP machines for the inactivation of G. stearothermophilus BIs, and cycle times were faster for the HPV system.
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| 8. |
- Holmdahl, Torsten, et al.
(författare)
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Hydrogen Peroxide Vapor Decontamination in a Patient Room Using Feline Calicivirus and Murine Norovirus as Surrogate Markers for Human Norovirus.
- 2016
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Ingår i: Infection Control & Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 37:5, s. 561-566
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine whether hydrogen peroxide vapor (HPV) could be used to decontaminate caliciviruses from surfaces in a patient room. DESIGN Feline calicivirus (FCV) and murine norovirus (MNV) were used as surrogate viability markers to mimic the noncultivable human norovirus. Cell culture supernatants of FCV and MNV were dried in triplicate 35-mm wells of 6-well plastic plates. These plates were placed in various positions in a nonoccupied patient room that was subsequently exposed to HPV. Control plates were positioned in a similar room but were never exposed to HPV. METHODS Virucidal activity was measured in cell culture by reduction in 50% tissue culture infective dose titer for FCV and by both 50% tissue culture infective dose titer and plaque reduction for MNV. RESULTS Neither viable FCV nor viable MNV could be detected in the test room after HPV treatment. At least 3.65 log reduction for FCV and at least 3.67 log reduction for MNV were found by 50% tissue culture infective dose. With plaque assay, measurable reduction for MNV was at least 2.85 log units. CONCLUSIONS The successful inactivation of both surrogate viruses indicates that HPV could be a useful tool for surface decontamination of a patient room contaminated by norovirus. Hence nosocomial spread to subsequent patients can be avoided. Infect. Control Hosp. Epidemiol. 2016;1-6.
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| 9. |
- Lanbeck, Peter, et al.
(författare)
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A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance
- 2016
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. Methods: We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. Results: According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. Conclusion: The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.
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| 10. |
- Lanbeck, Peter
(författare)
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Antibiotics and infusion phlebitis. Clinical and experimental studies.
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Intravenous administration of antibiotics is often followed by infusion phlebitis. In this condition are vessel irritation, inflammation and sometimes superficial thrombosis included. In this thesis, the risk for infusion phlebitis for various antibiotics has been evaluated in a clinical study in 550 patients. Various effects of four antibiotics on cultured endothelial cells have also been examined. The aim was to find a simple cytotoxic assay for assessment of the phlebitogenic properties of i.v. antibiotics. In the clinical studies, it was found that patients on treatment with i.v. antibiotics had a doubled risk for infusion phlebitis (odds ratio 2.34). Dicloxacillin, erythromycin, cloxacillin, benzylpenicillin and cefuroxime, in that order, were the antibiotics associated with a higher risk for infusion phlebitis. In pair-wise comparison, dicloxacillin was found to confer a higher risk than cloxacillin. Other significant risk factors were the insertion site of the peripheral venous catheter and patients being 51-60 years. In the experimental studies, dicloxacillin and erythromycin, but not benzylpenicillin or cefuroxime, were found to inhibit DNA-synthesis in endothelial cells. The inhibition was dose dependent and time-related. Antibiotic concentrations and incubation times in the experiments were close to those used in the clinic. Dicloxacillin and erythromycin increased the expression of ICAM-1 in human umbilical vein endothelial cells, a finding with possible implications of the pathogenesis of infusion phlebitis. In conclusion, the concordance of the clinical and experimental studies in this thesis indicates that testing of i.v. antibiotics on endothelial cells is a valid test model for phlebitis prediction
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