| 1. |
- Bäckman, Carl G
(författare)
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The photo-diary and follow-up appointment on the ICU: Giving back the time to patients and relatives. : A descriptive and interventional study
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients on the ICU often spend a great deal of their time either unconscious or heavily sedated. When they return from the zone between life and death they are often in a state of confusion where dreams and delusions are intertwined with reality and it is not always easy to distinguish them apart. These experiences could lead to psychological problems and post-traumatic stress disorder (PTSD). Recovery may be improved by filling in the significant memory gaps and explaining what really happened during the “chaotic” time on the ICU. The provision of a diary describing the patients’ stay in ICU on a day to day basis and a follow-up meeting (together named the ICU-diary concept), may help the whole family to understand.Aim: The principal aim of this thesis was to see if the ICU-diary concept was of help to patients and relatives in the recovery after critical illness. A further aim was to look for precipitants in the ICU of PTSD.Material and Methods: ICU patients in a handful of European countries and their relatives have been studied. The studies have been single and multi-centred and we have used descriptive observational, randomised controlled and cohort study designs, including matched case-control designs. Quantitative methods have been used with questionnaires and structured interviews using established instruments (i.e Post-traumatic stress syndrome screening-14, Post-traumatic diagnostic scale, ICU memory tool, Short Form-36, Pearlin-Schooler Mastery Scale, Hopelessness scale) as the principal means of data collection.Results: The ICU-diary concept was seen to be a positive and useful aid in helping patients and their relatives understand the events that took place during the time on the ICU. It also decreased the risk for PTSD among patients and relatives. Patients that were supported with the ICU-diary concept perceived a better health-related quality of life even 3 years after the ICU stay. We did not find any definite improvement by the ICU-diary concept in mastery and hope. Variations in how the patients were cared for in the ICU had a significant effect on the development of PTSD. The implementation of an ICU diary, for instance, was associated with a lower frequency of PTSD.Conclusions: The ICU-diary concept was found helpful by patients and their relatives. It was associated with a reduction in new onset PTSD and improved health-related quality of life. The results are encouraging and suggest that an ICU diary may represent an important first step to help patients and relatives come to terms with their experiences during critical illness.ISBN 978-
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| 2. |
- Holmqvist, Fredrik, 1979-
(författare)
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Populärhistoriens tjusning och kraft : Peter Englund och Herman Lindqvist i svensk historiekultur 1988-1995
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a study of popular history in Sweden from the late 1980’s to the mid 1990’s. The aim is to investigate and discuss Peter Englund’s and Herman Lindqvist’s historical accounts and their roles as public historians during the studied period. The study problematizes recurring issues in Sweden’s popular historical tradition, including the balance between cultivation and entertainment, culture and commercialism, academic and journalistic prose, impersonal style and the author as media celebrity. The focus is on the narrative structure of Englund’s and Lindqvist’s historical accounts, the mediated meaning of these accounts, and the mediated meaning of Englund and Lindqvist as popular historians. The analyses show that both Englund and Lindqvist developed a popular history that had its own constitutive character as a response to, and in contrast to, academic history, and it was based on their awareness of history as a public phenomenon. In different ways, both Englund and Lindqvist assent to more existential historical topics that the historical research had a limited interest in and understanding of, such as people's dreams, beliefs and life stories. In Englund’s more academic and complex popular history the appeal to the audience's reason and critical judgement and discernment is central. At the same time, he consistently appeals to the audience's emotions and the commercial success testifies to his ability to also sustain the audience’s interest, benevolence, confidence and sympathy. Lindqvist’s distinctly commercially oriented popular history, on the other hand, primarily involves appealing to the audience’s emotions and sympathy, which are clearly prioritized at the expense of the appeal to reason and critical judgement. If Englund’s historical accounts can be characterized as being critically educating and entertaining the audience, Lindqvist’s historical accounts can be characterized as informative entertainment. Among the general conclusions are that both Englund’s and Lindqvist's historical accounts lacked links to contemporary political, social or popular educational movements and therefore affirm claims that the dominant historical culture in Sweden from the 1980’s until the 2000’s was mainly characterized by history having become a personal interest or hobby.
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| 3. |
- Ander, Fredrik, 1978-
(författare)
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Perioperative complications in obese patients : A thesis on risk reducing strategies
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.
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| 4. |
- Berggren, Lars, et al.
(författare)
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Jubileumsblogg
- 2022
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Ingår i: Spänna brett & sikta högt : En jubileumsbok om nationella forskarskolan i Historiska studier och en festskrift till Hanne Sanders - En jubileumsbok om nationella forskarskolan i Historiska studier och en festskrift till Hanne Sanders. - Göteborg : Makadam Förlag. - 9789170614026 ; , s. 96-99
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Bokkapitel (populärvet., debatt m.m.)
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| 5. |
- Hindorf, Marie, et al.
(författare)
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Workload of Swedish Special Forces Operators Experienced During Stressful Simulation Training: A Pilot Study
- 2022
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Ingår i: Journal of Special Operations Medicine. - : Breakaway Media, LLC. - 1553-9768. ; 22:3, s. 42-48
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training.Methods: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA.Results: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found.Conclusion: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.
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| 6. |
- Jakobsson, Fredrik Lars Emil, 1974-
(författare)
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Charge transport modulation in organic electronic diodes
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Since the discovery of conducting polymers three decades ago the field of organic electronics has evolved rapidly. Organic light emitting diodes have already reached the consumer market, while organic solar cells and transistors are rapidly maturing. One of the great benefits with this class of materials is that they can be processed from solution. This enables several very cheap production methods, such as printing and spin coating, and opens up the possibility to use unconventional substrates, such as flexible plastic foils and paper. Another great benefit is the possibility of tailoring the molecules through carefully controlled synthesis, resulting in a multitude of different functionalities.This thesis reports how charge transport can be altered in solid-state organic electronic devices, with specific focus on memory applications. The first six chapters give a brief review of the field of solid-state organic electronics, with focus on electronic properties, resistance switch mechanisms and systems. Paper 1 and 3 treat Rose Bengal switch devices in detail – how to improve these devices for use in cross-point arrays as well as the origin of the switch effect. Paper 2 investigates how the work function of a conducting polymer can be modified to allow for better electron injection into an organic light emitting diode. The aim of the work in papers 4 and 5 is to understand the behavior of switchable charge trap devices based on blends of photochromic molecules and organic semiconductors. With this in mind, charge transport in the presence of traps is investigated in paper 4 and photochromic molecules is investigated using quantum chemical methods in paper 5.
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| 7. |
- Lindgren, Lenita, 1966-
(författare)
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Emotional and physiological responses to touch massage
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Clinical findings indicate that touch massage has the ability to induce positive emotions and influence stress responses. However, little is known about mechanisms that can explain observed responses.Aim: To understand mechanisms behind observed emotional and physiological responses during and after touch massage.Methods: This thesis is based upon healthy volunteers in Studies I, II, IV and patients undergone aortic surgery in Study III. Study I had a crossover design, participants served as their own controls. After randomization they received TM on one occasion and the other occasion served as control. Heart rate variability (HRV), heart rate (HR) saliva cortisol concentration, glucose, insulin in serum and extracellular (ECV) levels of glucose, lactate, glycerol and pyruvat were measured before, during and after TM/control. In study II, functional magnetic resonance imaging (fMRI) was used in order to measure brain activity during TM movement. The study design included four different touch stimulations, human touch with movement (TM movement) human stationary touch and rubber glove with or without movement. Force (2.5 N) and velocity (1.5 cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale). Study III had a randomized controlled design. The intervention group received TM and the control group rested. HRV, cortisol, glucose, insulin in serum, blood pressure, oxygen saturation, respiratory frequency and anxiety levels were measured before, during and after TM/control. In study IV participants were interviewed about experiences after TM and the text was analyzed in by qualitative content analyze.Results:Study I. TM reduced the stress response as indicated by decreased heart rate and decreased activity in the sympathetic nervous system, followed by a compensatory decrease in parasympathetic nervous activity in order to maintain balance. Cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control session. There were no significant differences in ECV concentrations of analyzed substances.Study II. Human moving touch (TM movement) was significantly rated as the most pleasant touch stimulation. The fMRI results revealed that human moving touch (TM movement) most strongly activated the pregenual anterior cingulate cortex (pgACC).Study III. Selfrated anxiety levels significantly decreased in the patient group that received TM compared with control group. There were no significant differences in physiological stress-related outcome parameters between patients who received touch massage and controls.Study IV. In this study participants talked about the experience of TM in terms of rewards. Expressions like need, desire, pleasure and conditioning could be linked with a theoretical model of reward. Four different categories were identified as wanting, liking, learning and responding.In conclusion: Results from these studies indicate that receiving TM is experienced as rewarding. Touch massage movement activates a brain area involved in coding of rewarding pleasant stimulations. TM decreases anxiety and dampens the stress response by a decreased activation of the sympathetic nervous activity. Our results indicate that TM is a caring intervention that can be used to induce pleasure, decrease anxiety and stress in the receiver.
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| 8. |
- Orwelius, Lotti, 1956-
(författare)
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Health related quality of life in adult former intensive care unit patients
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients.Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group.Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay.Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.
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