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- Adamski, Jan, et al.
(författare)
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Intensive care patient survival after limiting life-sustaining treatment-The FINNEOL* national cohort study
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 64:8, s. 1144-1153
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Tidskriftsartikel (refereegranskat)abstract
- Background Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions. Methods This retrospective observational study examined all patients treated in adult ICUs from 1 January 2016 until 31 December 2016 included in the Finnish ICU Registry. Multivariable logistic regression analysis was performed to explain the effect on survival. Results Decisions to limit LST were made for 2444 patients (13.7%; 95% CI 13.2-14.2). ICU, hospital, and 12-month survival rates were 71% (95% CI 69-73), 49% (95% CI 47-51), and 24% (95% CI 22-26), respectively. In patients for whom life support was withheld, increased 12-month survival rates were associated with admission from the operating theatre (OR 1.9, 95% CI 1.1-3.4), good pre-hospital physical fitness (OR 4.7, 95% Cl 1.2-16.8) and being housed at home (OR 2.0, 95% Cl 1.4-2.8). Decreased survival rates were associated with admission from a hospital ward (OR 0.67, 95% Cl 0.5-0.9), higher comorbidity (OR 0.6, 95% Cl 0.4-0.9), cancer (OR 0.4, 95%CI 0.2-0.9), greater illness severity (SAPS II; OR 0.98, 95% Cl 0.98-0.99), and higher care intensity (TISS-76; OR 0.93, 95% Cl 0.92-0.95). Conclusion Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.
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| 2. |
- Adamski, Jan, et al.
(författare)
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Predictors of treatment limitations in Finnish intensive care units
- 2022
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 66:4, s. 526-538
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Tidskriftsartikel (refereegranskat)abstract
- Background Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support (WHLS) at admission, WHLS during ICU stay and the withdrawal of ongoing life support (WDLS). Methods This retrospective observational study comprised 17,772 adult ICU patients who were included in the nationwide Finnish ICU Registry in 2016. Factors associated with LST limitations were identified using hierarchical logistic regression. Results The decision of WHLS at admission was made for 822 (4.6%) patients, WHLS during ICU stay for 949 (5.3%) patients, and WDLS for 669 (3.8%) patients. Factors strongly predicting WHLS at admission included old age (adjusted odds ratio [OR] for patients aged 90 years or older in reference to those younger than 40 years was 95.6; 95% confidence interval [CI], 47.2-193.5), dependence on help for activities of daily living (OR, 3.55; 95% CI, 3.01-4.2), and metastatic cancer (OR, 4.34; 95% CI, 3.16-5.95). A high severity of illness predicted later decisions to limit LST. Diagnoses strongly associated with WHLS at admission were cardiac arrest, hepatic failure and chronic obstructive pulmonary disease. Later decisions were strongly associated with cardiac arrest, hepatic failure, non-traumatic intracranial hemorrhage, head trauma and stroke. Conclusion Early decisions to limit LST were typically associated with old age and chronic poor health whereas later decisions were related to the severity of illness. Limitations are common for certain diagnoses, particularly cardiac arrest and hepatic failure.
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| 4. |
- Erlandsson, Markus, 1976, et al.
(författare)
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Standards and tools for eco-efficient rail vehicle design
- 2004
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Ingår i: International Conference on Eco-Efficiency, 1-3 April 2004, Leiden, Netherlands.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Through the EU-project REPID the railway industry takes a big leap forward, towards a solution to the issue of introducing Design for Environment (DfE) in the development of the future rolling stock. The REPID (Rail sector framework and tools for standardising and improving usability of Environmental Performance Indicators and Data formats) project is an implementation of the successful FP5-project RAVEL (RAil VEhicLe eco-efficient design). Both UIC and UNIFE are partners in REPID, with the aim to reach a practical agreement on a set of Environmental Performance Indicators (EPIs), a practically useful and common material list, and an open data format for data exchange. The standardisation of EPIs and data format within the railway industry is a prerequisite to achieve meaningful and comparable measurement and communication of environmental performance.In the REPID project a design supportive software application is implemented by SEMCON Sweden. This application is used to analyse eco-efficiency of the design of trains and train-components, in terms of the standard-EPIs. The application can be integrated with existing product management systems, which is a prerequisite to achieve a widespread acceptance of its use in the daily work. In the REPID project, integration with the CAD-tool CatiaV5 has been used as a showcase. The basis in the REPID methodology is the common EPIs for communication and measurement of environmental performance. The common set of defined indicators is based on the policies of the rail operators and manufacturers. The EPIs provide support for both external communication of environmental requirements and performance between customers and suppliers, as well as internal communication between different functions within the company. For each design project, environmental targets expressed in terms of quantitative target values of the indicators are set for the product. These target values can then be compared to calculated values of the actual environmental performance for the design. The quantitative measurements of the environmental performance are based on the well-defined common material properties for all the materials in the standardised material list. These material properties are aggregated according to calculation rules that are specified for each indicator. The material list and material property definitions have been developed through a systematic procedure and data management process by the Department of Industrial Environmental Informatics (IMI) at Chalmers University of Technology. The material property data needed for the calculations have also been acquired in accordance with a data management process including documentation, review and quality assessment. IMI is also responsible for maintenance of the DfE-methodology. By using the standardised EPIs and data format the railway industry takes a giant leap towards better environmental performance and will continue to walk at the head of eco-efficient transportation.
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