| 1. |
- Alkaissi, Aidah, 1953-
(författare)
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Postoperative Symptoms After Gynaecological Surgery : How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness.Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III).Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009).Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness.
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| 2. |
- Almqvist, Sara, et al.
(författare)
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Fördjupad analys av den svenska klimatomställningen 2020 : Klimat och luft i fokus
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sverige har ambitiösa klimatåtaganden där regeringen uttalat att Sverige ska bli världens första fossilfria välfärdsland. Riksdagen har antagit ambitiösa mål för att minska utsläppen av växthusgaser i Sverige för att vara med i omställningen och begränsa den globala uppvärmningen i linje med Parisavtalet. Under 2017 antog riksdagen ett klimatpolitiskt ramverk för Sverige med nya klimatmål. Det långsiktiga klimatmålet innebär att Sverige senast år 2045 inte ska ha några nettoutsläpp av växthusgaser till atmosfären, för att därefter uppnå negativa utsläpp. Det innebär att utsläppen av växthusgaser inom Sveriges gränser ska ha minskat med minst 85 procent senast år 2045 jämfört med utsläppen år 1990.Naturvårdsverket visar vägen mot klimatmålenNaturvårdsverket ansvarar för uppföljningen av Sveriges nationellt fastställda klimatmål. Årets rapport innehåller fördjupade analyser av trender i den svenska klimatomställningen för Sveriges utsläpp och nettoupptag av växthusgaser och ger en övergripande bild av hur vi befinner oss på vägen mot Sveriges klimatmål. Rapporten innehåller ett särskilt fokuskapitel som beskriver möjligheter med att integrera åtgärdsstrategier i luft- och klimatarbetet.Sveriges utsläpp av växthusgaser minskar för långsamtSveriges territoriella utsläpp av växthusgaser var 50,9 miljoner ton koldioxidekvivalenter år 2019, vilket motsvarar en minskning om 2,4 procent jämfört med 2018. För att nå det långsiktiga klimatmålet om nettonollutsläpp till 2045 krävs en genomsnittlig minskningstakt om 6–10 procent per år från 2019.Det senaste årets utsläppsminskning beror främst på minskade utsläpp inom industrisektorn och el- och fjärrvärmesektorn. Inom industrin har utsläppen framför allt minskat på grund av planerade underhållsstopp på raffinaderier och minskad produktion inom mineralindustrin. Minskade utsläpp syns i de flesta sektorerna, förutom jordbrukssektorn och arbetsmaskiner där utsläppen har ökat jämfört med föregående år.
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| 3. |
- Aspholm-Hurtig, Marina, et al.
(författare)
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Functional adaptation of BabA, the H. pylori ABO blood group antigen binding adhesin.
- 2004
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Ingår i: Science (New York, N.Y.). - : American Association for the Advancement of Science (AAAS). - 1095-9203 .- 0036-8075. ; 305:5683, s. 519-22
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Tidskriftsartikel (refereegranskat)abstract
- Adherence by Helicobacter pylori increases the risk of gastric disease. Here, we report that more than 95% of strains that bind fucosylated blood group antigen bind A, B, and O antigens (generalists), whereas 60% of adherent South American Amerindian strains bind blood group O antigens best (specialists). This specialization coincides with the unique predominance of blood group O in these Amerindians. Strains differed about 1500-fold in binding affinities, and diversifying selection was evident in babA sequences. We propose that cycles of selection for increased and decreased bacterial adherence contribute to babA diversity and that these cycles have led to gradual replacement of generalist binding by specialist binding in blood group O-dominant human populations.
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| 4. |
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| 5. |
- Björkman Björkelund, Karin, et al.
(författare)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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Ingår i: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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| 6. |
- Björkman Björkelund, Karin, et al.
(författare)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 7. |
- Björkman Björkelund, Karin, et al.
(författare)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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Ingår i: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 8. |
- Borgquist, Lars, et al.
(författare)
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The Relationship between Health-state Utilities and the SF-12 in a General Population
- 1999
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Ingår i: Medical decision making. - : SAGE. - 1552-681X .- 0272-989X. ; 19:2, s. 128-140
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Tidskriftsartikel (refereegranskat)abstract
- It would be a major advance if quality-of-life instruments could be translated into health- state utilities. The aim with this study was to investigate the relationship between the SF-12 and health-state utilities, based on responses to a postal questionnaire sent to a random sample of 8,000 inhabitants, aged 20-84 years, in the general population. The questionnaire included the SF-12, a rating-scale (RS) question, and a time-tradeoff (TTO) question; the response rate was 68%. Age, gender, and the 12 items of the SF- 12 were used as explanatory variables in a linear regression analysis of the health- state utilities. The regression models explained about 50% of the variance in the RS answers and about 25% of the variance in the TTO answers. Most of the SF-12 items were related to the health-state utilities in the expected ways, with especially strong results for the RS method. The results suggest that the SF-12 can be converted to health-state utilities, but that further work is needed to reliably estimate the conversion function. Key words: health status; SF-12; rating scale; time-tradeoff; health-related quality of life; health-state utilities; population study. (Med Decis Making 1999;19:128- 140)
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| 9. |
- Borjesson, Mats, et al.
(författare)
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Spinal cord stimulation in severe angina pectoris - A systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain
- 2008
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 140:3, s. 501-508
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Tidskriftsartikel (refereegranskat)abstract
- Patients who continue to stiffer from lasting and severely disabling angina pectoris despite Optimum drug treatment and who are not suitable candidates for invasive procedures,. suffer from a condition referred to as "chronic refractory angina pectoris". Based on the available data, spinal cord Stimulation, SCS, is considered Lis the first-fine additional treatment for these patients by the European Society or Cardiology. However, no systematic review of randomised controlled Studies has yet been published. A systematic literature research, 1966-2003, as part of the Swedish Board of Health and Welfare (SBU) report oil long-standing pain, and ail additional research covering the years 2003-2007, were carried out. Acute Studies, case reports and mechanistic reviews were excluded, and the remaining 43 Studies were graded for Study quality according to a modified Jadad score. The eight medium-to high-score studies formed the basis for Conclusions regarding the scientific evidence (strong, moderately strong or limited) for the efficacy of SCS. There is strong evidence that SCS gives rise to symptomatic benefits (decrease in anginal attacks) and improved quality of life in patients with severe angina pectoris. There is also a strong evidence that SCS call improve the functional status Of these patients, as illustrated by the improved exercise time oil treadmill or longer walking distance without angina. In addition, SCS does not seem to have any negative effects on mortality in these patients (limited scientific evidence). The complication rate was found to be acceptable. (C) 2008 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.
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| 10. |
- Boström, Barbro, et al.
(författare)
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A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
- 2003
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Ingår i: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 12:5, s. 726-735
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Tidskriftsartikel (refereegranskat)abstract
- A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. ○ Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) < 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. ○ Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. ○ The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.
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