| 1. |
- Ahlqvist-Bjorkroth, Sari, et al.
(författare)
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Improving NICU staff decision-making with parents in medical rounds : a pilot study of reflective group dialogue intervention
- 2023
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Ingår i: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process.Methods: This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy.Results: Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons.Conclusions: The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
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| 2. |
- Ali, Hassan, et al.
(författare)
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Cost Estimation of CO2 Absorption Plants for CO2 Mitigation – Method and Assumptions
- 2019
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Ingår i: International Journal of Greenhouse Gas Control. - : Elsevier BV. - 1750-5836. ; 88, s. 10-23
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Tidskriftsartikel (refereegranskat)abstract
- The estimates of post combustion CO2 capture costs reported in the literature range from 50 €/tCO2 to 128 €/tCO2, reflecting differences in the cost estimation methods used, scopes of the analyses, and assumptions made. This variation in calculated costs is important when evaluating the feasibility of a technology and highlights the importance of ensuring consistency and transparency in cost estimations. This study establishes a cost estimation tool that highlights the effects of different assumptions on the overall cost of a capture plant and identifies the crucial technical and economic factors. The input is a simplified process flow diagram and equipment list. Detailed installation factors and the equipment cost are the two main elements used to derive the capital expenditures (CAPEX), which represent a fundamental component of the cost estimation approach. A detailed installation factor sheet is used for the capital cost estimation. The method is applied to a Base case that involves the capture of CO2 from the flue gas of a process industry, giving a capture cost of 62.5 €/tCO2. The Base case results reveal that the steam cost, electricity cost, and capital cost are the main contributors. This method can provide an overview of the main cost drivers, and a sensitivity analysis of the variable input parameters can be performed simply and quickly. The results obtained using this method can be valuable in the early phase of the project and contribute to decision making.
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| 3. |
- Ali, Hassan, et al.
(författare)
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Cost estimation of heat recovery networks for utilization of industrial excess heat for carbon dioxide absorption
- 2018
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Ingår i: International Journal of Greenhouse Gas Control. - : Elsevier BV. - 1750-5836. ; 74, s. 219-228
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Tidskriftsartikel (refereegranskat)abstract
- The absorption of CO 2 using solvents (e.g., amines) is considered a state-of-the-art, albeit energy-intensive process for CO 2 capture. While it is generally recognized that the utilization of waste heat has potential to reduce the energy-associated costs for CO 2 capture, the cost of waste heat recovery is seldom quantified. In this work, the cost of heat-collecting steam networks for waste heat recovery for solvent regeneration is estimated. Two types of networks are applied to waste heat recovery from the flue gases of four process industries (cement, silicon, iron & steel, and pulp & paper) via a heat recovery steam generator (HRSG). A novel approach is presented that estimates the capital and operational expenditures for waste heat recovery from process industries. The results show that the overall cost (CAPEX + OPEX) of steam generated from one hot flue gas source is in the range of 1.1–4.1 €/t steam. The cost is sensitive to economic parameters, installation factors, the overall heat transfer coefficient, steam pressure, and to the complexity of the steam network. The cost of steam from an existing natural gas boiler is roughly 5–20-times higher than that of steam generated from recovered waste heat. The CAPEX required to collect the heat is the predominant factor in the cost of steam generation from waste heat. The major contributor to the CAPEX is the heat recovery steam generator, although the length of the steam pipeline (when heat is collected from two sources or over long distances) is also important for the CAPEX.
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| 4. |
- Aromada, Solomon Aforkoghene, et al.
(författare)
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Techno-Economic Assessment of Different Heat Exchangers for CO2 Capture
- 2020
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Ingår i: Energies. - : MDPI AG. - 1996-1073 .- 1996-1073. ; 13:23
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Tidskriftsartikel (refereegranskat)abstract
- We examined the cost implications of selecting six different types of heat exchangers as the lean/rich heat exchanger in an amine-based CO2 capture process. The difference in total capital cost between different capture plant scenarios due to the different costs of the heat exchangers used as the lean/rich heat exchanger, in each case, is in millions of Euros. The gasketed-plate heat exchanger (G-PHE) saves significant space, and it saves considerable costs. Selecting the G-PHE instead of the shell and tube heat exchangers (STHXs) will save euro33 million-euro39 million in total capital cost (CAPEX), depending on the type of STHX. About euro43 million and euro2 million in total installed costs (CAPEX) can be saved if the G-PHE is selected instead of the finned double-pipe heat exchanger (FDP-HX) or welded-plate heat exchanger, respectively. The savings in total annual cost is also in millions of Euros/year. Capture costs of euro5/tCO(2)-euro6/tCO(2) can be saved by replacing conventional STHXs with the G-PHE, and over euro6/tCO(2) in the case of the FDP-HX. This is significant, and it indicates the importance of clearly stating the exact type and not just the broad classification of heat exchanger used as lean/rich heat exchanger. This is required for cost estimates to be as accurate as possible and allow for appropriate comparisons with other studies. Therefore, the gasketed-plate heat exchanger is recommended to save substantial costs. The CO2 capture costs of all scenarios are most sensitive to the steam cost. The plate and frame heat exchangers (PHEs) scenario's capture cost can decline from about euro77/tCO(2) to euro59/tCO(2) or rise to euro95/tCO(2).
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| 5. |
- Backes, Carl, et al.
(författare)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 6. |
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| 7. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP) : protocol for a randomised controlled trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Preterm infants are at risk of negative consequences from stress and pain at the same time as they often are in need of intensive care that includes painful interventions. One of the frequent painful procedures preterm infants undergo is eye examination screening to detect early signs of ROP (retinopathy of prematurity). These examinations are both stressful and painful, and despite a multitude of research studies, no conclusive pain-relieving treatment has been demonstrated. The main aim of this trial is to investigate the analgesic effect of clonidine during ROP eye examinations.Methods and analysis The planned study is a multicentre randomised controlled trial with a crossover design. Infants will be recruited from two different neonatal intensive care units (NICUs) in Sweden. Infants born before gestation week 30 (and therefore eligible for ROP screening) and cared for in either of the NICUs will be eligible for inclusion in the study. The primary outcome will be Premature Infant Pain Profile–Revised score within 30 s after starting the examination. Secondary outcomes will be changes in the galvanic skin response parameters (area small peaks, area huge peaks, peaks per second and average rise time) within 30 s after starting the eye examination, together with the number and evaluation of adverse events reported within 72 hours after the examination and the examining physician’s assessment of how easy the infant was to examine.Ethics and dissemination Approval from the Swedish Ethical Review Authority and the Swedish Medical Products Agency has been obtained for the study. Parents of eligible infants will be getting both verbal and written information about the study including that participation is voluntary. Data will be collected and treated in accordance with the European general data protection regulations. The results will be reported on group level and published in a scientific journal.
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| 8. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants -cloROP
- 2024
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Konferensbidrag (refereegranskat)abstract
- BackgroundPreterm infants are vulnerable and sensitive to stimuli, during their stay in neonatal intensive care they undergo frequent stressful and painful procedures. One of these painful procedures is the screening for retinopathy of prematurity, ROP. In Sweden all preterm infants born before gestation week 30 undergo ROP-screening. The screening involves regular eye examinations to detect ROP at the early stages and these examinations are both stressful and painful. Several studies have investigated different ways of pain management during eye examinations with inconsequent results. No study has investigated Clonidine as pain management during ROP-screening. AimThe aim of this clinical trial is to investigate the analgesic effect of clonidine during ROP eyeexaminations.MethodThis study is a multicenter randomized controlled clinical trial with a crossover design. Infants born before gestation week 30 and therefore undergoing ROP-screening, will be eligible for inclusion in the study. Infants will be recruited from two Swedish NICUs (neonatal intensive care units). The NICUs use different examination techniques, where NICU A uses indirect ophthalmoscopy while NICU B uses RetCam. A total of 50 infants will be recruited (25 at each NICU). During the first eye examination the infant will be randomized to either clonidine 4mcg/kg or sterile water in the equivalent dose 60 minutes before the eye examination. The order of the treatment is blinded for everyone except the nurse preparing the study solution. During the second eye examination the infant will receive the study solution, (intervention or placebo) that he/she did not receive the first time. The primary outcome of the study is pain assessment with the Premature Infant Pain Profile – Revised. The infants´ face and monitor showing oxygen saturation and heart rate will be videorecorded to be able to assess the pain afterwards. The secondary outcome is Galvanic Skin Response where three probes are attached to the infant’s foot sole to register changes in the sweat gland activity in response to stimuli such as pain or stress. The ophthalmologist performing the eye examination will also rate how easy it was to examine the infant by marking an X on a 10cm VAS scale with “very easy to examine” on one end and “very difficult to examine” on the other end. Data collection is ongoing with 19 infants included at the moment.
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| 9. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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| 10. |
- Diderholm, Barbro, 1965-, et al.
(författare)
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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants
- 2022
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 14:4
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Tidskriftsartikel (refereegranskat)abstract
- The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.
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