| 1. |
- Björling, Gunilla, Docent
(författare)
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Long-Term Tracheostomy : Outcome, Cannula care, and Material Wear
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Do people with long-term tracheostomy need hospital care? Which cleaning method is most appropriate for decontamination of inner cannulae? Are tracheostomy tubes changed for rational reasons? There is clearly a lack of evidence based research in this field and the clinical guidelines available are often based on local practice. A tracheostomy is a created opening in trachea to facilitate breathing. It is a direct entry to the deeper airways, e.g. for micro-organisms causing a potential risk for lung infections. Indications for long-term tracheostomy can be, e.g. upper airway obstruction, malformations, or chronic hypoventilation, when ventilation via nasal mask is not possible. The research of the present thesis was conducted at the National Respiratory Centre (NRC) at Danderyd Hospital in Stockholm, Sweden. This unit opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The overall aims of the thesis were to evaluate the outcome of patients with long-term tracheostomy and to conduct evidence based studies concerning their care.A comparison was made for the number of days in hospital care during the 2-year periods before and after the tracheostomy was established. The life expectancy of the general population and the observed life span of a cohort of tracheostomized patients from the start of NRC in 1982 were also compared. Interestingly enough, the need for hospital care was unchanged despite of the tracheostomy. The patients’ observed life spans were remarkably high and for many patients not lower than the life expectancy of Swedish people in general.To find a practical and safe decontamination method for inner cannulae we compared two different cleaning methods; detergent followed by chlorhexidine-alcohol, or detergent alone. Samples for bacterial culture were taken before and after cleaning and the numbers of bacteria colonies were counted. The effectiveness of both cleaning methods was greater than expected and the results showed a nearly total elimination of organisms. Thus, the methods investigated were equivalent in achieving decontamination.The duration of use in our unit for polymeric tracheostomy tubes, i.e. silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) was determined and compared. We found, that Si tubes were used for longer periods (three months) than tubes made of PU or PVC (both two months).Whether or not surface changes could be observed on the tracheostomy tubes after 30 days’, three and six months’ exposure in the trachea were investigated in collaboration with the Royal Institute of Technology and Sophiahemmet University College in Stockholm, Sweden. The analyzing methods were Scanning Electron Microscopy, Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy, and Differential Scanning Calorimetry. All tubes, except one, showed changes in the surface after 30 days’ exposure. The surface changes had progressed significantly after three and six months' exposure, compared to the changes detected after 30 days. The SF-36 questionnaire and a study specific questionnaire were used to describe the patients’ health-related quality of life and experiences of long-term tracheostomy. The results show that all patients were satisfied with their tracheostomy and demonstrated a numerically mean mental health status score above that of the general population.In summary, long-term tracheostomy does not increase the need for hospital care nor does it reduce a patient’s life span. Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination. Si tracheostomy tubes are used longer compared to those made of PVC or PU. The polymeric material investigated suffered evident surface changes after 30 days’ use. Clinical use of polymeric tracheostomy tubes beyond three months cannot be recommended, as we found extensive surface changes and degradation of the polymeric chains. All patients were, in general content, with their tracheostomy. The findings from the present thesis contribute to making the care of long-term tracheostomized patients’ evidence based.
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| 2. |
- Danielsson, Katarina, 1983-
(författare)
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Delayed Sleep Phase Disorder : Prevalence, Diagnostic aspects, Associated factors and Treatment concepts
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder. Persons with DSPD have great difficulties falling asleep and waking up at conventional times. To diagnose DSPD this delayed sleep-wake rhythm should cause social impairment and distress for the individual. Evening melatonin and morning bright light are the recommended treatments. The overall aim of this thesis was to evaluate at-home treatment with Light therapy (LT) and the feasibility of adding cognitive behavior therapy (CBT) to LT in DSPD, furthermore prevalence, diagnostic aspects and associated factors were investigated.Study I included 673 randomly selected individuals aged 16–26 years. The prevalence of DSPD was 4.0%. Unemployment (defined as an absence of educational or work activities) and an elevated level of anxiety were associated with DSPD.In study II, dim light melatonin onset (DLMO) was measured in healthy adults. Time for DLMO DLMO (Mean±SD) was 20:58±55 minutes.Studies III, IV, and V present results from a randomized controlled trial examining the feasibility of CBT as an additive treatment to LT with scheduled rise times, in persons with DSPD. Sleep onset and sleep offset was significantly advanced from baseline (03:00±1:20; 10:22±2:02 respectively) to the end of LT (01:27±1:41; 08:05±1:29, p<0.001 respectively). This advancement was predicted by consistent daily usage of the LT-lamp. At the follow-ups after LT and CBT or LT alone, sleep onset remained stable, sleep offset was delayed, and sleep difficulties were further improved, but there was no significant group interaction over time. There was a significant group interaction over time in the severity of anxiety and depressive symptoms, both in favor of the LT+CBT group.Conclusively, DSPD was common among adolescents and young adults and it was associated with unemployment and elevated levels of anxiety. DLMO appeared in the expected time range in healthy working adults. At-home treatment with LT with scheduled rise times advanced sleep-wake rhythm and improved sleep difficulties in DSPD. Even though sleep-wake rhythm was not further advanced or better preserved in the participants that received LT+CBT compared to LT alone, the addition of CBT to the treatment regimen was feasible and well accepted.
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| 3. |
- Jönson Ring, Ingrid, 1971-
(författare)
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Nocturnal enuresis and rapid maxillary expansion : – long-term effect, prognostic variables, respiration during sleep and quality of life
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background:The orthodontic technique rapid maxillary expansion (RME) has been reported to have a potentially curative effect on nocturnal enuresis (NE). The mechanism behind this is unknown but could possibly be due to placebo and/or effects on respiration during sleep. Aim: This thesis aims to approach an answer to the following questions, with a randomized, placebo-controlled method: 1) Does rapid maxillary expansion have a curative effect on therapy-resistant NE? 2) Is the potential curative effect due to respiratory events that can be measured during sleep? 3) Do enuretic children have an impaired quality of life (QoL)? Subjects & Methods: In study I we evaluated the QoL in enuretic children while assessing the test re-test reliability of a Swedish version of an established QoL questionnaire. Study II and IV assess respiration during sleep in children with NE; in study II comparisons are made with healthy control children and in study IV we evaluate the respiratory effects of RME. Study III is a randomized placebo-controlled study investigating whether RME is a useful therapy for NE and if the treatment effect is due to placebo.Results: Study I:The Swedish version of the questionnaire proved to be a reliable tool (Chronbach’s alpha 0.87) with excellent test-retest stability (ICC = 0.762). Enuresis affects the children’s QoL and interactions with peers.Study II:The hypopnea index (HI) and the oxygen desaturation index were both significantly higher in the enuretic children compared to the healthy controls, (p=0.04 and p=0.05) but all values fell within the normal range.Study III:RME resulted in a significant reduction in wet nights i.e. the mean number of wet nights out of 14 was 11.4 before and 9.2 after RME. (p=0.003) This was not observed in the placebo group (p=0.40).Study IV:There was a significant reduction of sleep efficiency during RME. (p=0.001) The mean HI was also affected. (p=0.005)Conclusions: • Children with nocturnal enuresis have an impaired self-esteem and their quality of life is affected in their relationship with friends.• There were no major differences in respiration during sleep between enuretic children and controls.• Rapid maxillary expansion reduces the number of wet nights in children with enuresis, but the effect is of limited clinical value.• The antienuretic effect does not seem to be due to a placebo effect of the appliance.• The majority of the children in our study sample did not have sleep disordered breathing as a co-morbidity to their nocturnal enuresis.
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| 4. |
- Backman, Sara, et al.
(författare)
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Material Wear of Polymeric Tracheostomy Tubes : A Six-Month Study
- 2009
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Ingår i: The Laryngoscope. - : Wiley. - 0023-852X .- 1531-4995. ; 119:4, s. 657-664
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The objectives were to study long-term material wear of tracheostomy tubes made of silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) after 3 and 6 months of clinical use. Study Design: The study has a prospective and comparative design. Methods: Nineteen patients with long-term tracheostomy, attending the National Respiratory Center in Sweden, were included, n = 6 with Si tubes, n = 8 with PVC tubes, and n = 5 with PU tubes. The tubes were exposed to the local environment, in the trachea for 3 and 6 months and analyzed by scanning electron microscopy, attenuated total reflectance Fourier transform infrared spectroscopy, and differential scanning calorimetry. Results: All tubes revealed severe surface changes. No significant differences were established after 3 or 6 months of exposure between the various materials. The changes had progressed significantly after this period, compared to previously reported changes after 30 days of exposure. The results from all analyzing techniques correlated well. Conclusions: All tubes, exposed in the trachea for 3-6 months, revealed major degradation and changes in the surface of the material. Polymeric tracheostomy tubes should be changed before the end of 3 months of clinical use.
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| 5. |
- Bergdahl, Lena, 1980-
(författare)
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Auricular acupuncture for insomnia
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cognitive behavioural therapy for insomnia (CBT-i) is the most effective treatment for insomnia. Studies show that auricular acupuncture (AA) may alleviate insomnia symptoms.The overall aim of the thesis was to compare treatment effects of auricular acupuncture (AA) with cognitive behavioural therapy for insomnia (CBT-i) on symptoms of insomnia, anxiety, depression, hypnotic drugs consumption and quality of life from short- and long-term perspectives.Paper I had a qualitative approach with a descriptive design. 16 participants received group-treatment with AA during their protracted withdrawal phase and were interviewed about their experiences. They participants experienced a reduction in protracted withdrawal symptoms, improved subjective sleep quality, a strong sensation of peacefulness and increased wellbeing.Paper II, III and IV present results from a randomised controlled trial in where the effects of group-treatment with AA and CBT-i were compared in short- and long-term using subjective (questionnaires and sleep diary) and objective (actigraphy) measurements.The results showed that CBT-i was superior to AA in reducing insomnia symptoms in both the short and long run. Both groups experienced significant long-term reduction of depressive symptoms. Further, both groups managed to maintain a decreased intake of hypnotic drugs at the end of the treatment when compared to baseline measurement. Short-term reduction of symptoms of anxiety and depression improved only in the AA group. The results from the objective actigraph recordings showed that the AA group slept more and the CBT-i group less after the treatment and that sleep patterns in both groups reverted to pre-treatment levels after 6 months.Conclusively: AA, as administered in this study, was not as good as CBT-i in treating insomnia symptoms, and should not be used as a stand-alone treatment for insomnia. Our results also demonstrate that prolonged sleep time does not necessarily yield better sleep, and that the perception of insomnia symptoms is not inevitably affected by sleep duration. AA was as effective as CBT-i in ending hypnotic drugs consumption. Moreover, AA was more successful than CBT-i in reducing symptoms of anxiety and depression in the short run. Further studies investigating AA for anxiety and depression are motivated.
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| 6. |
- Björling, Gunilla, Docent, et al.
(författare)
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Clinical use and material wear of polymeric tracheostomy tubes
- 2007
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Ingår i: The Laryngoscope. - : Lippincott Williams & Wilkins. - 0023-852X .- 1531-4995. ; 117:9, s. 1552-1559
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use. METHODS: Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference. RESULTS: Si tubes are used for longer periods of time than those made of PVC (P < .0001) and PU (P = .021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR. CONCLUSIONS: Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.
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| 7. |
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| 8. |
- Tsolakis, Nikolaos, et al.
(författare)
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Strategy of changing from tracheostomy and non‐invasive mechanical ventilation to diaphragm pacing in children with congenital central hypoventilation syndrome
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:6, s. 1245-1247
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Tidskriftsartikel (refereegranskat)abstract
- Congenital central hypoventilation syndrome (CCHS) is a rare disorder that affects central control of breathing and paediatric treatment varies worldwide. One approach is diaphragm pacing (DP), by phrenic nerve stimulation or direct diaphragm muscle stimulation, with or without a tracheostomy. In Sweden, non-invasive ventilation (NIV) has been the first-line ventilator support for patients with CCHS. However, disadvantages such as midface hypoplasia and unintentional leakage have required assessment over time. DP implants are provided at the National Reference Center for Diaphragm Pacing at Uppsala University Hospital, Sweden, at 3-4 years of age, when the upper airways have become more stable. Some international centres wait until children are older. Our aim was to evaluate switching patients with CCHS from mechanical ventilation, namely tracheostomy or NIV, to DP.
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