| 1. |
- Eriksson, Irene, et al.
(författare)
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The Early Awareness and Alert System in Sweden : History and Current Status
- 2017
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Ingår i: Frontiers in Pharmacology. - : Frontiers Media S.A.. - 1663-9812. ; 8
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Forskningsöversikt (refereegranskat)abstract
- The Swedish EAA System started as a regional initiative and rapidly grew to become a national level activity. An important feature of the system today is its complete integration into the national process for managed introduction and follow-up of new medicines. The system will continue to evolve as a response both to the changing landscape of health innovations and to new policy initiatives at the regional, national and international level.
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| 2. |
- Hauffman, Anna, et al.
(författare)
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Cocreated internet-based stepped care for individuals with cancer and concurrent symptoms of anxiety and depression : Results from the U-CARE AdultCan randomized controlled trial
- 2020
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Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 29:12, s. 2012-2018
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim was to evaluate the effects of cocreated internet-based stepped care (iCAN-DO) on anxiety, depression, posttraumatic stress, and health-related quality of life (HRQoL) in individuals with cancer and self-reported anxiety and/or depression symptoms, compared with standard care.Methods Clinically recruited individuals with breast, colorectal, or prostate cancer underwent online screening with the Hospital Anxiety and Depression Scale (HADS). Those with anxiety and/or depression symptoms (>7 on any of the HADS subscales) were randomized to iCAN-DO or standard care. iCAN-DO comprised psychoeducation and self-care strategies (step 1) and internet-based cognitive behavioral therapy (iCBT, step 2). Data were collected before randomization and at 1, 4, 7, and 10 months and analyzed with intention-to-treat regression analysis and randomization tests.Results Online screening identified 245 (27%) of 909 individuals who reported anxiety and/or depression symptoms. They were randomized to iCAN-DO (n = 124) or standard care (n = 121). Of them 49% completed the 10-month assessment, and in the iCAN-DO group 85% accessed step 1 and 13% underwent iCBT. iCAN-DO decreased the levels of symptoms of depression (−0.54, 95% confidence interval: −1.08 to −0.01, P < .05) and the proportion of individuals with symptoms of depression (P < .01) at 10 months, compared with standard care, according to HADS. There were no significant effects on anxiety, posttraumatic stress, or HRQoL.Conclusion Internet-based stepped care improves symptoms of depression in individuals with cancer. Further studies are needed to gain knowledge on how to optimize and implement internet-based support in oncology care.
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| 3. |
- Amato, Alberto, et al.
(författare)
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Grazer-induced transcriptomic and metabolomic response of the chain-forming diatom Skeletonema marinoi
- 2018
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Ingår i: ISME Journal. - : Springer Science and Business Media LLC. - 1751-7362 .- 1751-7370. ; 12, s. 1594-1604
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Tidskriftsartikel (refereegranskat)abstract
- Diatoms and copepods are main actors in marine food webs. The prey-predator interactions between them affect bloom dynamics, shape marine ecosystems and impact the energy transfer to higher trophic levels. Recently it has been demonstrated that the presence of grazers may affect the diatom prey beyond the direct effect of grazing. Here, we investigated the response of the chain-forming centric diatom Skeletonema marinoi to grazer cues, including changes in morphology, gene expression and metabolic profile. S. marinoi cells were incubated with Calanus finmarchicus or with Centropages typicus and in both cases responded by reducing the chain length, whereas changes in gene expression indicated an activation of stress response, changes in the lipid and nitrogen metabolism, in cell cycle regulation and in frustule formation. Transcripts linked to G protein-coupled receptors and to nitric oxide synthesis were differentially expressed suggesting involvement of these signalling transduction pathways in the response. Downregulation of a lipoxygenase in the transcriptomic data and of its products in the metabolomic data also indicate an involvement of oxylipins. Our data contribute to a better understanding of the gene function in diatoms, providing information on the nature of genes implicated in the interaction with grazers, a crucial process in marine ecosystems.
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| 4. |
- Andréasson, Frida, et al.
(författare)
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Differences in soil organic matter, extractable nutrients, and acidity in European beech (Fagus sylvatica L.) forest soils related to the presence of ground flora
- 2012
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Ingår i: Journal of Forest Research. - : Informa UK Limited. - 1341-6979 .- 1610-7403. ; 17:4, s. 333-342
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Tidskriftsartikel (refereegranskat)abstract
- Differences in soil organic matter (SOM) content, soil acidity, and soil exchangeable nutrients (NH4-N, NO3-N, Ca, K, Na, Mg) related to the presence of ground flora were studied. The study was carried out for a growing season in two different Fagus sylvatica L. forests in southern Sweden, and the differences in soil characteristics below naturally occurring patches of Deschampsia flexuosa (L.) Trin. or Anemone nemorosa L. were compared with those with no ground flora. Patches of D. flexuosa led to higher soil pH, but lower SOM, water content, base saturation, and NH4-N concentration compared with adjacent zones without D. flexuosa. The lower SOM content suggested an increased rate of decomposition which caused soil pH to increase because of release of basic cations. In the presence of A. nemorosa, pH was higher and the exchangeable acidity lower than for patches without the herb. In early spring, when A. nemorosa emerged and flowered, the NH4-N concentration was somewhat lower in the presence of the herb than when it was absent. For the evergreen grass D. flexuosa NH4-N concentrations were lower in patches with the grass later in the summer season (July). This work indicates the presence of spatial and temporal differences in nutrient circulation and decomposition on the small ground flora scale, which should be considered when studying nutrient and carbon cycles of temperate forests.
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| 5. |
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| 6. |
- Asplund, Linnea, et al.
(författare)
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Swedish Spring Wheat Varieties with the Rare High Grain Protein Allele of NAM-B1 Differ in Leaf Senescence and Grain Mineral Content
- 2013
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Some Swedish spring wheat varieties have recently been shown to carry a rare wildtype (wt) allele of the gene NAM-B1, known to affect leaf senescence and nutrient retranslocation to the grain. The wt allele is believed to increase grain protein concentration and has attracted interest from breeders since it could contribute to higher grain quality and more nitrogen-efficient varieties. This study investigated whether Swedish varieties with the wt allele differ from varieties with one of the more common, non-functional alleles in order to examine the effect of the gene in a wide genetic background, and possibly explain why the allele has been retained in Swedish varieties. Forty varieties of spring wheat differing in NAM-B1 allele type were cultivated under controlled conditions. Senescence was monitored and grains were harvested and analyzed for mineral nutrient concentration. Varieties with the wt allele reached anthesis earlier and completed senescence faster than varieties with the non-functional allele. The wt varieties also had more ears, lighter grains and higher yields of P and K. Contrary to previous information on effects of the wt allele, our wt varieties did not have increased grain N concentration or grain N yield. In addition, temporal studies showed that straw length has decreased but grain N yield has remained unaffected over a century of Swedish spring wheat breeding. The faster development of wt varieties supports the hypothesis of NAM-B1 being preserved in Fennoscandia, with its short growing season, because of accelerated development conferred by the NAM-B1 wt allele. Although the possible effects of other gene actions were impossible to distinguish, the genetic resource of Fennoscandian spring wheats with the wt NAM-B1 allele is interesting to investigate further for breeding purposes.
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| 7. |
- Bergkvist, Anna, et al.
(författare)
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A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management
- 2009
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Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley. - 1365-2753 .- 1356-1294. ; 15:4, s. 660-667
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives To evaluate if an integrated medicines management can lead to a more appropriate drug use in elderly inpatients. Method The study was an intervention study at a department of internal medicine in southern Sweden. During the intervention period pharmacists took part in the daily work at the wards. Systematic interventions aiming to identify, solve and prevent drug-related problems (DRPs) were performed during the patient's hospital stay by multidisciplinary teams consisting of physicians, nurses and pharmacists. DRPs identified by the pharmacist were put forward to the care team and discussed. Medication Appropriateness Index (MAI) was used to evaluate the appropriateness in the patients' drug treatment at admission, discharge and 2 weeks after discharge. In total 43 patients were included, 28 patients in the intervention group and 25 patients in the group which was used as control. Results For the intervention group there was a significant decrease in the number of inappropriate drugs compared with the control group (P = 0.049). Indication, duration and expenses were the MAI-dimensions with most inappropriate ratings, and the drugs with most inappropriate ratings were anxiolytics, hypnotics and sedatives. Conclusion This kind of systematic approach on drug therapy can result in a more appropriate drug use in the elderly.
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| 8. |
- Bergkvist, Anna
(författare)
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A systematic approach to improving pharmacotherapy in the elderly
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate whether a structured and systematic approach on improving pharmacotherapy in the elderly (the LIMM-model) would lead to a more appropriate and accurate drug use in the elderly. The elderly use many drugs and are more prone to suffer from adverse drug reaction. It is therefore important to address the quality of their drug therapy. The first study presented in this thesis showed that medication errors in the transition of care are common. These results contributed to the development of the LIMM-model. The model consists of patient medication interview at admission (including medication reconciliation), medication review during the hospital stay and a discharge summary with a medication report at discharge (including medication reconciliation). The activities are performed by the clinical pharmacists and the health care team in close collaboration. The opportunity to study the full model arose as the department of internal medicine at Landskrona Hospital was interested in improving drug therapy in the elderly by using clinical pharmacy services. We therefore started the Landskrona Integrated Medicines management – the LIMM-study. The studies presented here add information and knowledge on clinical relevant topics regarding drug therapy in the elderly, as great room for improvement has been shown to exist in this field. The LIMM-model can help improve the drug therapy in the individual patient, the transfer of information between care levels, is highly appreciated by the health care personnel and is considered very beneficial both for the health care personnel and for the patients.
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| 9. |
- Bergkvist, Anna, 1995-, et al.
(författare)
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Distal radius fractures in children aged 5-12 years : a Swedish nationwide register-based study of 25 777 patients
- 2023
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR).METHODS: In this retrospective study, based on data from SFR for children aged 5-12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed.RESULTS: In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74-0.89, p < .001). With age 5 -7 years as reference, OR for age group 8-10 years was 0.88 (95% CI 0.80-0.98 p = .019) and OR for age group 11-12 years was 0.81 (95% CI 0.73-0.91 p = < .001.CONCLUSION: Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.
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| 10. |
- Bergkvist, Anna, et al.
(författare)
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Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
- 2009
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 1037-1046
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.
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| 11. |
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| 12. |
- Bergkvist, Anna, et al.
(författare)
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The process of identifying, solving and preventing drug related problems in the LIMM-study
- 2011
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 33:6, s. 1010-1018
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Tidskriftsartikel (refereegranskat)abstract
- Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient's drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service. Setting Three wards at a department of internal medicine. Method Pharmacists performed systematic interventions during the patient's hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel's attitudes towards the process. Main outcome measure The number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel's attitudes towards the model. Results In total, 1,227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. Conclusion The process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance.
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| 13. |
- Bergkvist, John, et al.
(författare)
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Maintenance and enhancement of forest ecosystem services: a non-industrial private forest owner perspective
- 2023
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Ingår i: European Journal of Forest Research. - 1612-4669 .- 1612-4677.
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Tidskriftsartikel (refereegranskat)abstract
- The transition to a fossil-free society in Sweden is expected to cause an increased demand for forest-derived products which may intensify existing conflicts between forest ecosystem services. This study investigated the preferences among non-industrial private forest owners for maintaining multiple forest ecosystem services and their preferences for future forest development. The findings were related to their prioritizations for and knowledge of forest management. The study results were generated through the means of a survey which revealed a consistent high valuation among all respondents of ecosystem services relating to water quality, timber quality, recreation, and biodiversity. A majority of the respondents desired increasing proportions of mixed species and broadleaved stands within the future forest landscape. Certified forest owners who were members of a forest owner association (CMs) prioritized achieving high economic income through roundwood production with strong preferences for the ecosystem services high stand growth and high timber quality. For CMs, carbon substitution was the preferred means of mitigating climate change. Forest owners lacking both certification and membership in a forest owner association ranked the ecosystem services recreation and biodiversity significantly higher, and also preferred retaining more old forest within the landscape. The survey results revealed a higher management activity among CMs, resulting in a more frequent establishment of mixed and broadleaved stands. Forest owners with medium to large scale properties were well-represented within the CM category. The results indicated that while the CMs have stronger preferences for roundwood production compared to owners of small properties, they are also more likely to have taken adaptive measures favoring risk management and biodiversity.
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| 14. |
- Bergkvist, John, et al.
(författare)
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Modelling managed forest ecosystems in Sweden : An evaluation from the stand to the regional scale
- 2023
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Ingår i: Ecological Modelling. - : Elsevier BV. - 0304-3800. ; 477
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Tidskriftsartikel (refereegranskat)abstract
- Incorporation of a forest management module in the dynamic vegetation model LPJ-GUESS has allowed the study and predictions of management treatment effects on the carbon cycle and on forest ecosystem structure. In this study, LPJ-GUESS is evaluated at the regional scale against observational data from the Swedish National Forest Inventory. Simulated standing volume is compared against observations for the four most common forest types in the country. Furthermore, eddy-covariance flux measurements from the Integrated Carbon Observation System (ICOS) are used to evaluate model predictions of net ecosystem exchange (NEE), gross primary productivity (GPP) and ecosystem respiration (Reco) at the site scale. The model results suggest an adequate representation of standing volume in monocultures of Norway spruce and Scots pine for regional simulations in southern and central Sweden, after an updated parameterization of the species. For northern Sweden, the standing volume in Norway spruce monocultures was overestimated with the updated parameter values. At the stand scale, the model produced mixed results for carbon fluxes when evaluated against eddy-covariance data for two sites, one in central and one in southern Sweden. The interannual variation of GPP was well captured for the central Swedish site, but the modelled average GPP for the period 2015–2019 was overestimated by 9%. For the southern Swedish site, GPP was underestimated by 15% for the corresponding period and the simulated interannual variation was half of the observed. The seasonal estimates of modelled net ecosystem exchange (NEE) deviated from observations and the simulated standing volume was underestimated by 25% for both sites. The results highlight further potential to perform species-specific calibration to capture latitudinal gradients in key ecosystem properties, and to incorporate additional characteristics of site quality which could benefit model accuracy at the scale of individual forest stands, both regarding simulated carbon fluxes and forest stand variables.
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| 15. |
- Bergkvist, John, et al.
(författare)
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Modelling managed forest ecosystems in Sweden : Poster presentation
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In this work, the forestry-enabled dynamic vegetation model LPJ-GUESS was used to simulate forest standing volume for the three main regions of Sweden. At the regional scale, the model results were evaluated against observational data from the Swedish National Forest Inventory. Carbon fluxes of net ecosystem exchange (NEE), gross primary productivity (GPP), and ecosystem respiration (Reco) were simulated at the local scale on a daily time step for two sites in Sweden and results were evaluated against data from the Integrated Carbon Observation System (ICOS). The model produced adequate results of standing volume in monocultures of Norway spruce and Scots pine for southern and central Sweden, after an updated parameterization of the species. Stand-scale simulations of carbon fluxes produced mixed results after an evaluation against EC data from ICOS.
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| 16. |
- Bötzl, Fabian, et al.
(författare)
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Undersowing oats with clovers supports pollinators and suppresses arable weeds without reducing yields
- 2023
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Ingår i: Journal of Applied Ecology. - : Wiley. - 0021-8901 .- 1365-2664. ; 60, s. 614-623
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Tidskriftsartikel (refereegranskat)abstract
- Sustainable food production requires agriculture to conserve biodiversity and facilitate ecosystem services to maintain productivity levels while reducing inputs detrimental to ecosystem functioning. Increasing within-field vegetation diversity by legume intercropping seems promising to facilitate cropping system multi-functionality. Effects of intercropping with legumes on biodiversity-mediated ecosystem services such as pollination or natural pest control are, however, not sufficiently understood. Using 26 observation plots in a paired field design, we studied the effects of undersowing oats with a mixture of three annual clovers across different aspects of cropping system multi-functionality. We investigated 16 below- and above-ground ecosystem service indicators related to soil mineral nitrogen, arable weed control, pollination, disease and pest pressures, natural pest control and crop yield. We found lower arable weed cover, higher flower cover and pollinator densities as well as decreased root-feeding nematode densities in intercropped observation plots compared with the non-intercropped controls. However, intercropping decreased spider activity densities and oat yield nitrogen content. Root diseases, pest damages, natural pest control and crop yield were not affected by intercropping. The biomass of undersown clovers was positively related with the differences in flower cover and pollinator densities, and negatively related with the differences in arable weed cover between the intercropped and the control treatment. Synthesis and applications: We demonstrate that undersowing annual clovers suppresses arable weeds and simultaneously support pollinators without reducing crop yields or taking land out of arable production. Undersown plant mixtures should, however, be tailored to support a wider spectrum of pollinators and benefit natural pest control to support a higher level of overall cropping system multi-functionality.
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| 17. |
- Engström, Jens, et al.
(författare)
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Energy absorption from parks of point-absorbing wave energy converters in the Swedish exclusive economic zone
- 2020
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Ingår i: Energy Science & Engineering. - : John Wiley & Sons. - 2050-0505. ; 8:1, s. 38-49
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Tidskriftsartikel (refereegranskat)abstract
- In a future energy system based on renewable energy sources, wave energy will most likely play a role due to its high energy potential and low intermittency. The power production from parks of wave energy converters of point absorber type has been extensively studied. This is also the case for the wave energy resource at many coastal areas around the globe. Wave energy has not yet reached a commercial level, and a large variety of technologies exist; therefore, an established method to calculate the technical potential for wave energy has still not been established. To estimate the technical potential of wave energy conversion, some approximations inevitably need to be taken due to the systems high complexity. In this study, a detailed mapping of the wave climate and simulation of large arrays of hydrodynamically cross‐coupled wave energy converters are combined to calculate the technical potential for wave energy conversion in the Swedish exclusive economic zone. A 16‐year wave data set distributed in a 1.1 km × 1.1 km grid is used to calculate the absorbed energy from a park of 200 generic point absorbers. The areas with best potential have an average annual energy absorption of 16 GWh for the selected wave energy park adapted to 1 km2 when using a constant damping, while the theoretical upper bound is 63 GWh for the same area.
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| 18. |
- Enlund, Mats, et al.
(författare)
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Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane
- 2023
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Ingår i: EClinicalMedicine. - : Elsevier. - 2589-5370. ; 60
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Tidskriftsartikel (refereegranskat)abstract
- Background Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. Methods From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and perprotocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Findings Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P = 0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR = 1.01 (0.71-1.44); P = 0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P = 0.829, log rank test). Interpretation No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.
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| 19. |
- Enlund, Mats, et al.
(författare)
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Long-term survival after volatile or propofol general anesthesia for bladder cancer surgery : a retrospective national registry cohort study
- 2024
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Ingår i: Anesthesiology. - : American Society of Anesthesiologists. - 0003-3022 .- 1528-1175. ; 140:6, s. 1126-1133
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. In specific, bladder cancer surgery lacks prospective clinical trial evidence.METHODS: Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from The National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a five-percentage point difference in five-year survival.RESULTS: Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in ASA physical status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median 45 months [interquartile range, 33 to 62]) in neither the full unmatched cohort, nor following 1:1 propensity score matching (3,052 matched pairs). The Kaplan-Meier adjusted five-year survival rates in the matched cohort were 898/3,052, 67.5% (65.7-69.3) for propofol and 852/3,052, 68.5% (66.7-70.4) for inhaled volatile general anesthesia, respectively (hazard ratio 1.05 [95% CI: 0.96 to 1.15], P = 0.332). A sensitivity analysis restricted to 1,766 propensity score matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan-Meier adjusted five-year-survival rates were 521/1,766, 67.1% (64.7-69.7) and 482/1,766, 68.9% (66.5-71.4) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio 1.09 [95% CI: 0.97 to 1.23], P = 0.139).CONCLUSIONS: Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance.
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| 20. |
- Enlund, Mats, et al.
(författare)
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Rationale and Design of the CAN Study : An RCT of Survival after Propofol- or Sevoflurane-based Anesthesia for Cancer Surgery
- 2019
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Ingår i: Current pharmaceutical design. - : BENTHAM SCIENCE PUBL LTD. - 1381-6128 .- 1873-4286. ; 25:28, s. 3028-3033
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Tidskriftsartikel (refereegranskat)abstract
- Background: Based on animal data only, some clinicians have adopted pmpofol-based anesthesia for cancer surgery with the aim of increased survival.Objective: Our objective is to verify or refute the hypothesis that survival increases after cancer surgery with propofol compared with sevoflurane for anesthesia maintenance. This aim deserves a large-scale randomized study. The primary hypothesis is an absolute increase of minimum 5%-units in 1- and 5-year survival with propofol-based anesthesia for breast or colorectal cancer after radical surgery, compared with sevoflurane-based anesthesia.Method: Ethics and medical agency approvals were received and pre-study registrations at clinicaltrial.gov and EudraCT were made for our now ongoing prospective, randomized, open-label, multicenter study. A power analysis based on a retrospective study, including a safety margin for drop outs, resulted in a total requirement of 8,000 patients. The initial inclusion period constituted a feasibility phase with an emphasis on the functionality of the infrastructure at the contributing centers and at the monitoring organization, as well as on protocol adherence.Conclusion: The infrastructure and organization work smoothly at the different contributing centers. Protocol adherence is good, and the monitors are satisfied. We expect this trial to be able to either verify or refute that propofol is better than sevoflurane for cancer surgery.
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| 21. |
- Enlund, Mats, et al.
(författare)
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Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia-A retrospective, multicenter, database analysis of 6305 Swedish patients
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 64:8, s. 1048-1054
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Tidskriftsartikel (refereegranskat)abstract
- Background: Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival.Methods: We identified all patients who were anaesthetized for breast cancer surgery between 2006 and 2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors, and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia was analyzed with different statistical approaches: (a) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, (b) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis.Results: The database analysis identified 6305 patients. The 5-year survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively, in the final model (P = .126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at 5 years (hazard ratio 1.46, 95% CI 1.10-1.95).Conclusions: It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.
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| 22. |
- Enlund, Mats, et al.
(författare)
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The choice of anaesthetic - sevoflurane or propofol - and outcome from cancer surgery : a retrospective analysis
- 2014
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 119:3, s. 251-261
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia.PATIENTS AND METHODS:Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan-Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders.RESULTS:Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant.CONCLUSION:Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
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| 23. |
- Enlund, Mats, et al.
(författare)
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Volatile versus Propofol General Anesthesia and Long-term Survival after Breast Cancer Surgery : A National Registry Retrospective Cohort Study
- 2022
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Ingår i: Anesthesiology. - : Lippincott Williams & Wilkins. - 0003-3022 .- 1528-1175. ; 137:3, s. 315-326
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several retrospective studies using administrative or single-center data have failed to show any difference between general anesthesia using propofol versus inhaled volatiles on long-term survival after breast cancer surgery. Although randomized controlled trials are ongoing, validated data from national clinical registries may advance the reliability of existing knowledge.Methods: Data on breast cancer surgery performed under general anesthesia between 2013 and 2019 from the Swedish PeriOperative Registry and the National Quality Registry for Breast Cancer were record-linked. Overall survival was compared between patients receiving propofol and patients receiving inhaled volatile for anesthesia maintenance.Results: Of 18,674 subjects, 13,873 patients (74.3%) received propofol and 4,801 (25.7%) received an inhaled volatile for general anesthesia maintenance. The two cohorts differed in most respects. Patients receiving inhaled volatile were older (67 yr vs. 65 yr), sicker (888 [19.0%] American Society of Anesthesiologists status 3 to 5 vs. 1,742 [12.8%]), and the breast cancer to be more advanced. Median follow-up was 33 months (interquartile range, 19 to 48). In the full, unmatched cohort, there was a statistically significantly higher overall survival among patients receiving propofol (13,489 of 13,873 [97.2%]) versus inhaled volatile ( 4,039 of 4,801 [84.1%]; hazard ratio, 0.80; 95% CI, 0.70 to 0.90; P < 0.001). After 1:1 propensity score matching (4,658 matched pairs), there was no statistically significant difference in overall survival (propofol 4,284 of 4,658 [92.0%]) versus inhaled volatile (4,288 of 4,658 [92.1%]; hazard ratio, 0.98; 95% CI, 0.85 to 1.13; P = 0.756).Conclusions: Among patients undergoing breast cancer surgery under general anesthesia, no association was observed between the choice of propofol or an inhaled volatile maintenance and overall survival.
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| 24. |
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| 25. |
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| 26. |
- Frisk, Jessica, 1971-
(författare)
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Acupuncture treatment for hot flushes in women with breast cancer and men with prostate cancer
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The group of women and men with a history of cancer and distressing hot flushes and sweating is growing. The flushes negatively affect Health Related Quality of Life (HRQoL), perhaps partially by disturbing sleep. Treatments that are effective, tolerable and safe need to be developed. There are a number of treatment alternatives that are often not very effective or associated with more or less serious side-effects. Based on theories on the mechanisms behind hot flushes and acupuncture, treatment with acupuncture has been tried in menopausal women with hot flushes and in a few studies in women with breast cancer (BCa).Aim: The general aim of the research leading to this thesis was to evaluate the effect of acupuncture on hot flushes, HRQoL and sleep in men with prostate cancer (PCa) and women with BCa. To evaluate the effect in women with BCa of 12 weeks of electrostimulated acupuncture (EA) and two years of hormone therapy (HT) on number of, and distress caused by, hot flushes, and on HRQoL and sleep. To evaluate whether acupuncture therapy could be used to treat hot flushes in men with PCa treated with castration therapy, and then to evaluate in men with PCa and hot flushes the effect of 12 weeks of traditional acupuncture (TA) or EA on number of, and distress caused by, hot flushes and on urinary excretion of CGRP, HRQoL and sleep.Subjects and methods: Forty-five women with a history of BCa were randomized to oral HT for two years or EA for 12 weeks and were followed up till two years after start of therapy. Thirty-eight men with PCa and hot flushes were treated with acupuncture. Seven men were treated with EA for 10 to 12 weeks in a pilot study. After positive results from this study 31 men were randomized between EA and TA for 12 weeks and followed up till nine months after end of treatment. Hot flushes, HRQoL and sleep were monitored by means of log books and validated questionnaires.Results: The pilot study showed that 10 to 12 weeks of EA in men with PCa reduced number of hot flushes to below 50% of baseline with persistent effects at a follow up three months later. The two randomized studies showed that treatment with acupuncture in women with a history of BCa, and men with PCa was associated with a decrease in both the number of and distress caused by hot flushes by at least 50%. HT almost eliminated the hot flushes. There was no difference in reduction of hot flushes between men receiving EA or TA. Reduction of the number of hot flushes and distress caused by hot flushes probably leads to decreased disturbances at night, and was associated in women with a significant improvement in HRQoL and sleep variables. The improvement in HRQoL was as great in women treated with EA as in women receiving HT although the latter group had a more substantial reduction in number of flushes than the EA group suggesting that EA might have other effects in addition to those on hot flushes. In the men HRQoL did not change significantly. We saw very few and non-serious side-effects in the acupuncture groups and no signs that acupuncture activated the cancer or ovarian/testicular function.Conclusions: Acupuncture reduced the number of hot flushes and distress caused by hot flushes with at least 50% in women and men with hot flushes and a cancer disease and also improved HRQoL and sleep at least in women. Acupuncture should be further evaluated in these patient groups and could be a treatment alternative in patients with troublesome symptoms.
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| 27. |
- Gunnarsdottir, Maria J., et al.
(författare)
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Status of risk-based approach and national framework for safe drinking water in small water supplies of the Nordic water sector
- 2020
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Ingår i: International Journal of Hygiene and Environmental Health. - : Elsevier BV. - 1438-4639. ; 230
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Tidskriftsartikel (refereegranskat)abstract
- Reliable safe water supply is a pillar of society and a key to public health. The Nordic countries have an abundance of clean fresh water as a source for drinking water supplies. They have followed developments in safeguarding water, both the recommendations of the World Health Organization framework for safe drinking water and European legislation. Worldwide, including the Nordic countries, small water supplies are less compliant with water safety regulation. The forthcoming EU directive on drinking water require risk-based approaches and improved transparency on water quality. This research looks at the Nordic frameworks for safe water supply, with emphasis on risk-based approaches and smaller systems. We analyzed the legal frameworks for safe water, the structure of the water sector across the Nordic countries and explored how prepared these countries are to meet these requirements. Our findings show that, while legal requirements are mostly in place, delivery of information to the public needs to be improved. Most Nordic countries are in the process of implementing risk-based management in large and medium size water supplies, whereas small supplies are lagging. We conclude that a key to success is increased training and support for small supplies. We suggest wider adoption of the Nordic model of cooperation with benchmarking of safe water for all to transfer knowledge between the countries. This work provides insights into challenges and opportunities for the Nordic countries and provides insights relevant to countries worldwide in their effort towards realization of SDG Target 6.1.
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| 28. |
- Hossain, Shakhawat, et al.
(författare)
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Aphanomyces pea root rot disease and control with special reference to impact of Brassicaceae cover crops
- 2012
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Ingår i: Acta Agriculturae Scandinavica, Section B - Soil and Plant Science. - : Informa UK Limited. - 0906-4710 .- 1651-1913. ; 62, s. 477-487
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Tidskriftsartikel (refereegranskat)abstract
- Pea root rot disease caused by the pathogen Aphanomyces euteiches deserves increased attention, since peas are an important cash crop and also improve the N balance in temperate agriculture. However, due to pea root rot it is difficult to cultivate peas as frequently and successfully as desired. In the search for biological measures to overcome this problem, attention has been drawn to the use of Brassicaceae plants as cover crops between main crops, since these can be effective catch crops for nutrients and also exert allelopathic effects. Many species within the Brassicaceae contain glucosinolates (GSLs). Their hydrolysis products, the volatile isothiocyanates (ITCs), have been shown to suppress soil-borne plant pathogens such as A. euteiches. In addition, Brassicaceae biomass releases water-soluble toxic substances such as oxazolidine-2-thione and supplies nutrients and organic matter. Overall, this influences the soil microbial community and the final suppression of pathogens. Due to the unpredictability of the control effect of Brassicaceae biomass incorporation into soil on the pathogen, there is a need to define the mechanisms behind suppression in the field situation. This review focuses on how incorporation of Brassicaceae biomass suppresses A. euteiches under field conditions and the effect on the emerging pea. Different factors influencing the severity of field pea (Pisum sativum L.) root rot disease are also discussed. One conclusion is that suppression of pea root rot depends on the quality and quantity of incorporated Brassicaceae biomass.
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| 29. |
- Hossain, Shakhawat, et al.
(författare)
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Brassicaceae cover crops reduce Aphanomyces pea root rot without suppressing genetic potential of microbial nitrogen cycling
- 2015
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Ingår i: Plant and Soil. - : Springer Science and Business Media LLC. - 0032-079X .- 1573-5036. ; 392, s. 227-238
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Tidskriftsartikel (refereegranskat)abstract
- Brassicaceae cover crops can be used to suppress soil-borne pathogens. The aim was to investigate the effect of different brassicas with different glucosinolate profiles on the development of Aphanomyces pea root rot in subsequent pea plants, and the genetic potential of free-living N-2-fixing bacteria and ammonia oxidising bacteria (AOB) and archaea (AOA) performing key soil ecosystem services.The Brassicaceae species Brassica juncea and Sinapis alba and non-Brassicaceae species Secale cereale were grown for 11-weeks in Aphanomyces euteiches infested soil at low and high nitrogen (N) fertiliser doses. After removing both shoots and roots of the cover crops, peas were grown as a bioassay to evaluate Aphanomyces pea root rot development. Soil was sampled before harvesting the cover crops and at the end of the bioassay. Volatile compounds were collected in the root-soil environment before harvesting the Brassicaceae cover crops to determine the concentration of isothiocyanates. The abundance of genes involved in N-2-fixing bacteria and ammonia oxidation in AOA and AOB were assessed.Pea root rot disease severity was reduced in Brassicaceae grown soil at the high N fertiliser dose. This was associated with increased growth of the cover crops. The growth of Brassicaceae did not suppress the abundance of N-cycling microbial communities, but rather increased the AOB at the end of the bioassay, most likely due to increased N availability. The disease suppressive effect was higher with S. alba than with B. juncea, and this coincided with a more diverse composition and higher concentration of aliphatic ITCs released from S. alba roots. Fewer nodules were formed after the Brassicaceae crops, especially Sinapis alba.Brassicaceae cover crops, particularly S. alba, can be used to control soil-borne pathogens without major side effects on the genetic potential of beneficial soil microorganisms involved in N cycling. However, less nodule formation after brassicas indicates an effect on rhizobium activity.
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| 30. |
- Hossain, Shakhawat, et al.
(författare)
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Concentration- and time-dependent effects of isothiocyanates produced from Brassicaceae shoot tissues on the pea root rot pathogen Aphanomyces euteiches
- 2014
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Ingår i: Journal of Agricultural and Food Chemistry. - : American Chemical Society (ACS). - 0021-8561 .- 1520-5118. ; 62, s. 4584-4591
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Tidskriftsartikel (refereegranskat)abstract
- Isothiocyanates (ITCs) hydrolyzed from glocosinolates (GSLs) in Brassicaceae tissue are toxic to soil organisms. In this study, the effect of aliphatic and aromatic ITCs from hydrated dy Brassicaceae shoot tissues on the mycelium and oospores of the pea root rot pathogen Aphanomyces euteiches was investigated. The profile and concentrations of GSLs in two test Brassicaceae species, Sinapis alba and Brassica juncea, and the ITCs from the dominant hydrolyzed parent GSLs were monitored. The concentrations of dominant ITCs and pathogen exposure time were evaluated in in vitro experiments. The greatest effect on the pathogen was observed from aliphatic ITCs hydrolyzed from B. juncea tissue, and the effect depended on the ITS concentration and exopsure time. ITCs were more effectively hydrolyzed from B. juncea GSLs than from S. alba GSLs; i.e., the ITC/GSL ratio was higher in B. juncea than in S. albatissue, giving a different release pattern. The release of phenylethyl isothiocyanate, which was common to both species, followed a pattern similar to that of the dominant ITC in each crop speices. This suggests that trait other than GSL content, e.g., plant cell structure, may affect the release of ITCs ans should therefore influence the choice of speices used for biofumigation purposes.
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| 31. |
- Islam, Md. Rafikul, et al.
(författare)
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Integrated Assessment of Climate Change and Forest Management Impacts on Carbon Fluxes and Biomass in a Southern Boreal Forest
- 2024
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Boreal forests play a crucial role in global carbon sequestration and storage, yet their vulnerability to climate change remains a significant concern. We present results from simulations with the process-based dynamic global vegetation model LPJ-GUESS of the combined effects of climate change and forest management on the carbon sink capacity of a boreal forest in southern Sweden. We compared two future climate change scenarios (RCP 4.5 and RCP 8.5) along with four forest management options against a baseline scenario without management interventions. Our findings indicate that projected temperature increases (+2 to +4°C) in the late 21st century will diminish the net carbon sink strength, particularly in old-growth forests. Clear-cut and subsequent reforestation resulted in a substantial decline (57-67%) in vegetation carbon during 2022-2100. The carbon compensation point (CCP) was reached 12-16 years after the clear-cut, indicating a period of carbon debt before the ecosystems resumed acting as a net carbon sink. Specific reforestation strategies, such as pine plantations, enhanced the overall net carbon sink by 7-20% relative to the baseline during 2022-2100. The carbon parity point, without considering harvested carbon, was reached 56-73 years after the clear-cut, highlighting the extended period required for the reforestation to achieve a carbon stock equivalent to the uncut baseline. These findings highlight the substantial influence of forest management on the net carbon budget, surpassing that of climate change alone. The adoption of relevant reforestation strategies could enhance carbon uptake, simultaneously improving forest productivity and ensuring the forest's vital role in carbon sequestration and storage amid a changing climate.
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| 32. |
- Islam, Md Rafikul, et al.
(författare)
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Projected effects of climate change and forest management on carbon fluxes and biomass of a boreal forest
- 2024
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Ingår i: Agricultural and Forest Meteorology. - 0168-1923. ; 349
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Tidskriftsartikel (refereegranskat)abstract
- Boreal forests are key to global carbon (C) sequestration and storage. However, the potential impacts of climate change on these forests could be profound. Nearly 70 % of the European boreal forests are intensively managed, but our understanding of the combined effects of forest management and climate change on the forest's integral role as a C sink is still limited. In this study, we aim to fill this gap with simulations of the process-based dynamic global vegetation model LPJ-GUESS. We evaluated the effects of four forest management options under two different climate scenarios (RCP 4.5 and RCP 8.5), at a southern boreal forest stand in Sweden. These options were compared against a baseline without clear-cut or management interventions. We found that the projected increase in temperatures (+2 to +4 °C) during the latter part of the 21st century will reduce the net C sink strength, particularly in the unmanaged forest. The standing biomass C for reforestations was projected to be 57–67 % lower in 2100 than in the old forest in 2022. The study also revealed that the C sequestration potential of replanted pine forests may surpass that of 200-years old forests in the far future (2076–2100). The study did not detect statistically significant differences in overall net C exchange between the clear-cut with subsequent reforestation options and the baseline, even though specific reforestation strategies, such as pine plantations, enhanced the overall net C sink by 7–20 % relative to the baseline during 2022–2100. These findings underscore the profound influence of forest management on the net C budget, surpassing that of climate change scenarios alone. By adopting pertinent reforestation strategies, C uptake could be augmented, with concurrently improved forest productivity, resulting in favourable outcomes for the forest's critical role in C sequestration and storage amidst a changing climate.
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| 33. |
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| 34. |
- Lehnbom, Elin C., et al.
(författare)
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Heart failure exacerbation leading to hospital admission : a cross-sectional study
- 2009
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Ingår i: Pharmacy World & Science. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 31:5, s. 572-579
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this pilot study was to investigate cause(s) of heart failure (HF). Setting The emergency department and medical wards at Malmo University Hospital. Method A cross sectional pilot study. Main outcome measures Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (a parts per thousand currency sign75 years) and elderly (> 75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. Results Of the 47 patients included, 60% reported high compliance, with significant differences between women and men, and between patients in NYHA class IV and patients in NYHA class III. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health professional in the case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern. The majority were treated with recommended agents, but had not achieved target dose as recommended in the guidelines. Conclusion This pilot study indicates suboptimal HF management of patients with HF prior to hospital admission due to HF exacerbation. A larger study is needed to assess the extent of the problem, and establish the need and nature of management improvement in different patient subgroups.
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| 35. |
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| 36. |
- Malm, Torsten, et al.
(författare)
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Transplantation och donation av vävnader - sex år med nya lagen. Erfarenheter från vävnadsbanken i Lund
- 2002
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Ingår i: Läkartidningen. - 0023-7205. ; 99:40, s. 43-3938
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Tidskriftsartikel (refereegranskat)abstract
- Tissue transplantation is more common than organ transplantation. Legislative changes in 1996 transformed tissue banking and conditions for tissue transplantation in Sweden. After an initial decrease in donated tissue, heart valves are now available in sufficient numbers, but there is sometimes a shortage of valves the right size for pediatric cardiac surgery. Since the new transplantation legislation was implemented there has been an increase in the number of valves from neonatal donation and after sudden infant death. The number of donated corneas does not correspond to the number required for transplantation. A number of tissue coordinators have been established throughout the country and recently some new tissue banks were founded to increase the amount of tissue available for transplantation. The organization of the tissue bank in Lund is described. There is a lack of knowledge about tissue transplantation and donation among health professionals as well as the general public, and more education is warranted.
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| 37. |
- Midlöv, Patrik, et al.
(författare)
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Medication errors when transferring elderly patients between primary health care and hospital care
- 2005
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 27:2, s. 116-120
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care. Method: Elderly primary health care patients (> 65 years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital. Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not. Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added. Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients' medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.
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| 38. |
- Midlöv, Patrik, et al.
(författare)
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Medication report reduces number of medication errors when elderly patients are discharged from hospital
- 2008
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 30:1, s. 92-98
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether a Medication Report can reduce the number of medication errors when elderly patients are discharged from hospital. Method We conducted a prospective intervention with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. Main outcome measures The main outcome measure was the number of medication errors when elderly patients were discharged from hospital. Results Among 248 patients in the intervention group 79 (32%) had at least one medication error as compared with 118 (66%) among the 179 patients in the control group. In the intervention group 15% of the patients had errors that were considered to have moderate or high risk of clinical consequences compared with 32% in the control group. The differences were statistically significant (P < 0.001). Conclusion Medication errors are common when elderly patients are discharged from hospital. The Medication Report is a simple tool that reduces the number of medication errors.
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| 39. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten : 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
- 2022
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Ingår i: Aftonbladet. - : Aftonbladet. ; :2022-12-07
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Vi, 1 620 forskare samt lärare vid universitet och högskolor, är eniga med de unga bakom Auroramålet: De drabbas och riskerar att drabbas allvarligt av klimatkrisen under sin livstid. De klimatåtgärder vi vidtar i närtid avgör deras framtid. Sverige måste ta ansvar och göra sin rättvisa andel av det globala klimatarbetet. I strid med Parisavtalet ökar utsläppen av växthusgaser i en takt som gör att 1,5-gradersmålet kan överskridas om några år. De globala effekterna blir allt mer synliga med ständiga temperaturrekord, smältande isar, havshöjning och extremväder som torka, förödande bränder och skyfall med enorma översvämningar, som i Pakistan nyligen. Försörjningen av befolkningen utsätts för allvarliga hot i många länder.Minskningen av den biologiska mångfalden är extrem. Klimatkrisen är enligt WHO det största hotet mot människors hälsa i hela världen och barn utgör en särskilt sårbar grupp. Med Sveriges nordliga läge sker uppvärmningen här dubbelt så fort som det globala genomsnittet. Det förskjuter utbredningsområden för växtlighet och sjukdomsbärande insekter och ökar förekomsten av extremväder såsom värmeböljor, skogsbränder och översvämningar samt av många olika sorters infektioner och allergier. När extremväder ökar, ökar även stressen och risken för mental ohälsa. Värmeböljor ökar risken för sjukdom och död hos sårbara grupper som äldre, små barn och personer med kroniska sjukdomar. De negativa effekterna på hälsan kommer att öka i takt med klimatkrisen och barn riskerar att drabbas av ackumulerade negativa hälsoeffekter under hela sina liv. Redan i dag är mer än hälften av unga mellan 12 och 18 år i Sverige ganska eller mycket oroliga för klimat och miljö. Detta är förståeligt när våra beslutsfattare inte gör vad som krävs.Den juridiska och moraliska grunden för arbetet mot klimatförändringarna är att varje land måste göra sin rättvisa andel av det globala klimatarbetet. Centralt i det internationella klimatramverket är att rika länder med höga historiska utsläpp, däribland Sverige, måste gå före resten av världen. Dessa länder måste också bidra till att finansiera klimatomställningen i länderna i det Globala Syd, som är minst ansvariga för klimatkrisen men drabbas hårdast. Denna rättviseprincip är tydlig i Parisavtalet och var en het diskussionsfråga under COP27 i Sharm el-Sheikh, men lyser med sin frånvaro i det svenska klimatarbetet. Sverige har satt mål för att minska sina utsläpp. Men de är helt otillräckliga: minskningstakten är för låg och målen tillåter samtidigt att åtgärder skjuts på framtiden. Dessutom exkluderas merparten av Sveriges utsläpp från de svenska nationella utsläppsmålen; bland annat utelämnas utsläpp som svensk konsumtion orsakar utanför Sveriges gränser, utsläpp från utrikes transporter och utsläpp från markanvändning och skogsbruk, exempelvis utsläpp från förbränning av biobränslen eller utsläpp från dikade våtmarker (Prop. 2016/17:146 s.25-28).Sverige saknar dessutom ett eget mål för att öka upptaget av växthusgaser genom utökat skydd och restaurering av ekosystem, något som krävs för att begränsa de värsta konsekvenserna av klimatkrisen (IPCC s.32). Trots dessa låga ambitioner misslyckas Sverige med att nå sina utsläppsmål, konstaterar både Klimatpolitiska rådet och Naturvårdsverket. En klimatpolitik i linje med Parisavtalet kräver både att alla typer av växthusgasutsläpp minskar samtidigt som – inte i stället för – upptaget av växthusgaser maximeras: i dag misslyckas Sverige på bägge fronter.Slutsatsen är tydlig. Sverige vidtar inte de åtgärder som krävs för att skydda barns och ungdomars rättigheter enligt Europakonventionen till skydd för de mänskliga rättigheterna. Detta medför allvarliga risker för liv och hälsa för unga generationer, människor i andra länder och särskilt utsatta grupper. Detta kan inte fortsätta. Därför ställer vi oss bakom Auroras krav att Sverige börjar göra sin rättvisa andel och omedelbart sätter igång ett omfattande och långtgående klimatarbete som vilar på vetenskaplig grund och sätter rättvisa i centrum.
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