| 1. |
- Alkaissi, Aidah, 1953-
(author)
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Postoperative Symptoms After Gynaecological Surgery : How They Are Influenced by Prophylactic Antiemetics Sensory Stimulation (P6-Acupressure)
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness.Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III).Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p <0.009).Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (>30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (>30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness.
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| 2. |
- Almqvist, Sara, et al.
(author)
-
Fördjupad analys av den svenska klimatomställningen 2020 : Klimat och luft i fokus
- 2020
-
Reports (other academic/artistic)abstract
- Sverige har ambitiösa klimatåtaganden där regeringen uttalat att Sverige ska bli världens första fossilfria välfärdsland. Riksdagen har antagit ambitiösa mål för att minska utsläppen av växthusgaser i Sverige för att vara med i omställningen och begränsa den globala uppvärmningen i linje med Parisavtalet. Under 2017 antog riksdagen ett klimatpolitiskt ramverk för Sverige med nya klimatmål. Det långsiktiga klimatmålet innebär att Sverige senast år 2045 inte ska ha några nettoutsläpp av växthusgaser till atmosfären, för att därefter uppnå negativa utsläpp. Det innebär att utsläppen av växthusgaser inom Sveriges gränser ska ha minskat med minst 85 procent senast år 2045 jämfört med utsläppen år 1990.Naturvårdsverket visar vägen mot klimatmålenNaturvårdsverket ansvarar för uppföljningen av Sveriges nationellt fastställda klimatmål. Årets rapport innehåller fördjupade analyser av trender i den svenska klimatomställningen för Sveriges utsläpp och nettoupptag av växthusgaser och ger en övergripande bild av hur vi befinner oss på vägen mot Sveriges klimatmål. Rapporten innehåller ett särskilt fokuskapitel som beskriver möjligheter med att integrera åtgärdsstrategier i luft- och klimatarbetet.Sveriges utsläpp av växthusgaser minskar för långsamtSveriges territoriella utsläpp av växthusgaser var 50,9 miljoner ton koldioxidekvivalenter år 2019, vilket motsvarar en minskning om 2,4 procent jämfört med 2018. För att nå det långsiktiga klimatmålet om nettonollutsläpp till 2045 krävs en genomsnittlig minskningstakt om 6–10 procent per år från 2019.Det senaste årets utsläppsminskning beror främst på minskade utsläpp inom industrisektorn och el- och fjärrvärmesektorn. Inom industrin har utsläppen framför allt minskat på grund av planerade underhållsstopp på raffinaderier och minskad produktion inom mineralindustrin. Minskade utsläpp syns i de flesta sektorerna, förutom jordbrukssektorn och arbetsmaskiner där utsläppen har ökat jämfört med föregående år.
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| 3. |
- Aspholm-Hurtig, Marina, et al.
(author)
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Functional adaptation of BabA, the H. pylori ABO blood group antigen binding adhesin.
- 2004
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In: Science (New York, N.Y.). - : American Association for the Advancement of Science (AAAS). - 1095-9203 .- 0036-8075. ; 305:5683, s. 519-22
-
Journal article (peer-reviewed)abstract
- Adherence by Helicobacter pylori increases the risk of gastric disease. Here, we report that more than 95% of strains that bind fucosylated blood group antigen bind A, B, and O antigens (generalists), whereas 60% of adherent South American Amerindian strains bind blood group O antigens best (specialists). This specialization coincides with the unique predominance of blood group O in these Amerindians. Strains differed about 1500-fold in binding affinities, and diversifying selection was evident in babA sequences. We propose that cycles of selection for increased and decreased bacterial adherence contribute to babA diversity and that these cycles have led to gradual replacement of generalist binding by specialist binding in blood group O-dominant human populations.
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| 4. |
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| 5. |
- Björkman Björkelund, Karin, et al.
(author)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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In: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
-
Journal article (peer-reviewed)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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| 6. |
- Björkman Björkelund, Karin, et al.
(author)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
-
Journal article (peer-reviewed)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 7. |
- Björkman Björkelund, Karin, et al.
(author)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
-
In: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
-
Journal article (peer-reviewed)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 8. |
- Borgquist, Lars, et al.
(author)
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The Relationship between Health-state Utilities and the SF-12 in a General Population
- 1999
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In: Medical decision making. - : SAGE. - 1552-681X .- 0272-989X. ; 19:2, s. 128-140
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Journal article (peer-reviewed)abstract
- It would be a major advance if quality-of-life instruments could be translated into health- state utilities. The aim with this study was to investigate the relationship between the SF-12 and health-state utilities, based on responses to a postal questionnaire sent to a random sample of 8,000 inhabitants, aged 20-84 years, in the general population. The questionnaire included the SF-12, a rating-scale (RS) question, and a time-tradeoff (TTO) question; the response rate was 68%. Age, gender, and the 12 items of the SF- 12 were used as explanatory variables in a linear regression analysis of the health- state utilities. The regression models explained about 50% of the variance in the RS answers and about 25% of the variance in the TTO answers. Most of the SF-12 items were related to the health-state utilities in the expected ways, with especially strong results for the RS method. The results suggest that the SF-12 can be converted to health-state utilities, but that further work is needed to reliably estimate the conversion function. Key words: health status; SF-12; rating scale; time-tradeoff; health-related quality of life; health-state utilities; population study. (Med Decis Making 1999;19:128- 140)
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| 9. |
- Borjesson, Mats, et al.
(author)
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Spinal cord stimulation in severe angina pectoris - A systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain
- 2008
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In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 140:3, s. 501-508
-
Journal article (peer-reviewed)abstract
- Patients who continue to stiffer from lasting and severely disabling angina pectoris despite Optimum drug treatment and who are not suitable candidates for invasive procedures,. suffer from a condition referred to as "chronic refractory angina pectoris". Based on the available data, spinal cord Stimulation, SCS, is considered Lis the first-fine additional treatment for these patients by the European Society or Cardiology. However, no systematic review of randomised controlled Studies has yet been published. A systematic literature research, 1966-2003, as part of the Swedish Board of Health and Welfare (SBU) report oil long-standing pain, and ail additional research covering the years 2003-2007, were carried out. Acute Studies, case reports and mechanistic reviews were excluded, and the remaining 43 Studies were graded for Study quality according to a modified Jadad score. The eight medium-to high-score studies formed the basis for Conclusions regarding the scientific evidence (strong, moderately strong or limited) for the efficacy of SCS. There is strong evidence that SCS gives rise to symptomatic benefits (decrease in anginal attacks) and improved quality of life in patients with severe angina pectoris. There is also a strong evidence that SCS call improve the functional status Of these patients, as illustrated by the improved exercise time oil treadmill or longer walking distance without angina. In addition, SCS does not seem to have any negative effects on mortality in these patients (limited scientific evidence). The complication rate was found to be acceptable. (C) 2008 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.
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| 10. |
- Boström, Barbro, et al.
(author)
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A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
- 2003
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In: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 12:5, s. 726-735
-
Journal article (peer-reviewed)abstract
- A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. ○ Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) < 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. ○ Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. ○ The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.
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| 11. |
- Boström, Barbro, et al.
(author)
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Cancer patients' experiences of care related to pain management before and after palliative care referral
- 2004
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In: European Journal of Cancer Care. - : Wiley-Blackwell. - 0961-5423 .- 1365-2354. ; 13:3, s. 238-245
-
Journal article (peer-reviewed)abstract
- Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.
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| 12. |
- Boström, Barbro, et al.
(author)
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Cancer-related pain in palliative care : patients' perceptions of pain management
- 2004
-
In: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 45:4, s. 410-419
-
Journal article (peer-reviewed)abstract
- Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.
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| 13. |
- Boström, Barbro, et al.
(author)
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Pain and health-related quality of life among cancer patients in final stage of life : a comparison between two palliative care teams
- 2003
-
In: Journal of Nursing Management. - Chichester, West Sussex : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 11:3, s. 189-196
-
Journal article (peer-reviewed)abstract
- A two-centred descriptive study was performed in order to describe and compare pain and health-related quality of life (HRQOL) among cancer patients, in their final stage of life. The patients were cared for by either a nurse-led palliative care team I (PCT I) or a physician-led palliative care team II (PCT II). Forty-six consecutive, stratified patients (PCT I, n = 21 and PCT II, n = 25) participated. The medical outcomes study short form 36 (SF-36) was used for evaluating HRQOL and the Pain-O-Meter for assessing pain. Patients' pain intensity, pain quality and HRQOL showed no significant difference between the two groups PCT I and PCT II. The patients from PCT I had significantly longer survival time (P = 0.017) than those from PCT II. The different composition of the teams being led by nurses or physicians is worth further research; both from the patient's and staff's viewpoint, there may also be cost-benefits worth examining.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Granberg Axèll, Anetth, et al.
(author)
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Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment.
- 2002
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 46:6, s. 726-731
-
Journal article (peer-reviewed)abstract
- BACKGROUND: We have performed a prospective qualitative investigation of the ICU syndrome/delirium; the main parts of which have recently been published. The aim of the present study was to explore the relationship between the ICU syndrome/delirium and age, gender, length of ventilator treatment, length of stay and severity of disease, as well as factors related to arterial oxygenation and the amount of drugs used for sedation/analgesia. METHODS: Nineteen mechanically ventilated patients who had stayed in the ICU for more than 36 h were closely observed during their stay, and interviewed in depth twice after discharge. Demographic, administrative and medical data were collected as a part of the observation study. RESULTS: Patients with severe delirium had significantly lower hemoglobin concentrations than those with moderate or no delirium (P=0.033). Patients suffering from severe delirium spent significantly longer time on the ventilator and at the ICU, and were treated with significantly higher daily doses of both fentanyl (P=0.011) and midazolam (P=0.011) in comparison with those reporting only moderate or no symptoms of delirium. There were no significant differences in the Therapeutic Intervention Scoring System scores, reflecting the degree of illness, between patients with and without delirium. CONCLUSION: The development of the ICU syndrome/delirium seems to be associated with decreased hemoglobin concentrations and extended times on the ventilator. Prolonged ICU stays and treatment with higher doses of sedatives and opioids in patients with delirium appear to be secondary phenomena rather than causes.
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| 18. |
- Hedén, Lena, 1971-
(author)
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Distressing Symptoms in Children with Cancer in General; During Needle Procedures in Particular
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The main aims of this thesis were to investigate the effect of distraction, midazolam and morphine on fear, distress, and pain during needle procedures, and to longitudinally describe parents’ perceptions of their children’s symptom burden during and after cancer treatment.The design in Study I-III was that of a randomized controlled trial (RCT) conducted in a medical setting; Studies II-III were placebo controlled. Study IV has a longitudinal design, and data were collected at three times during treatment and three times after the end of successful treatment. Participants in Study I were children aged 1 to 7 (n=28), in Study II children aged 1 to 19 (n=50), in Study III children aged 1 to 19 (n=50), and in Study IV parents (n=160) of children aged 1 to 19.Blowing soap bubbles or having a heated pillow reduces children’s fear and distress in connection with needle procedures. Low-dose oral midazolam 0.3mg/kg body weight is effective in reducing fear and distress, especially in younger children. Interestingly, oral morphine at a dose of 0.25mg/kg body weight does not reduce fear, distress or pain.These studies have evaluated interventions that may be of help for the most frightened children during needle procedures. We suggest that the first-line intervention against procedural fear, distress, and/or pain should be standard care (i.e. EMLA) in addition to distraction interventions when needed, and only when this is insufficient to add pharmacological interventions.According to parents, feeling drowsy, pain, and lack of energy are initially the most prevalent symptoms in their children, whereas less hair than usual is the most prevalent symptom during treatment. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout treatment. The child’s symptom burden, as reported by parents, decreases over time. Information about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during and after cancer treatment.
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| 19. |
- Hedner, Jan A, 1953, et al.
(author)
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Effects of TRH and TRH analogues on the central regulation of breathing in the rat.
- 1983
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In: Acta physiologica Scandinavica. - : Wiley. - 0001-6772 .- 1365-201X. ; 117:3, s. 427-37
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Journal article (peer-reviewed)abstract
- Respiratory activity was studied in rats during light halothane anesthesia. Thyrotropin releasing hormone (TRH) and two TRH analogues: the desamidated form (TRH-OH) and gamma-butyrolactone-gamma-carbonyl-L-histidyl-L-prolinamide citrate (DN 1417) were administered intracerebroventricularly. TRH 0.5-5 micrograms induced a marked tachypnoea with a rapid onset and a duration of at least 20 min. DN 1417, a potent analogue of TRH with a very low TSH (thyroid stimulating hormone) releasing activity was more effective in stimulating respiratory frequency, while TRH-OH, regarded to have neither TSH releasing nor extra hypothalamic effects, at equimolar doses was unable to induce any changes in the respiratory pattern. When TRH was given into the fourth ventricle the dose response curve was slightly shifted to the left. In experiments employing the occluded breath technique, P0.1 was increased in the same magnitude as the mean inspiratory flow (VT/T1). The results also indicated an increase in the gain of the inflation reflex loop whereas the central bulbopontine setting for T1 and TTOT were not significantly changed. Local injection of TRH into the nucleus tractus solitarii induced a stimulation of respiratory frequency which was slower in onset compared to the response seen after injection into the lateral or fourth ventricles. Concomitantly to the respiratory changes, i.c.v. TRH injection induced a hypocarbia and an alkalosis. No changes in blood pressure or heart rate were seen. The respiratory stimulant effect of TRH could be potentiated by pretreatment with naloxone, methylatropine or a low dose of GABA. Haloperidol or propranolol did not significantly change the respiratory effects of TRH, while reserpine pretreatment seemed to blunt some of the ventilatory effects of TRH. It seems likely that TRH has few direct effects on brain stem neurones involved in the central regulation of respiration, but the main effects seem to be elicited in areas rostral to the brain stem. The respiratory stimulating effect of TRH is unrelated to TSH. Furthermore, other neurotransmitter systems might also be involved in modulation of the respiratory stimulation evoked by TRH.
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| 20. |
- Hilland, Eva, et al.
(author)
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Aberrant default mode connectivity in adolescents with early-onset psychosis : A resting state fMRI study
- 2022
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In: NeuroImage. - : Elsevier. - 2213-1582. ; 33
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Journal article (peer-reviewed)abstract
- Abnormal default mode network (DMN) connectivity has been found in schizophrenia and other psychotic disorders. However, there are limited studies on early onset psychosis (EOP), and their results show lack of agreement. Here, we investigated within-network DMN connectivity in EOP compared to healthy controls (HC), and its relationship to clinical characteristics. A sample of 68 adolescent patients with EOP (mean age 16.53 +/- 1.12 [SD] years, females 66%) and 95 HC (mean age 16.24 +/- 1.50 [SD], females 60%) from two Scandinavian cohorts underwent resting state functional magnetic resonance imaging (rsfMRI). A group independent component analysis (ICA) was performed to identify the DMN across all participants. Dual regression was used to estimate spatial maps reflecting each participant's DMN network, which were compared between EOP and HC using voxel-wise general linear models and permutation-based analyses. Subgroup analyses were performed within the patient group, to explore associations between diagnostic subcategories and current use of psychotropic medication in relation to connectivity strength. The analysis revealed significantly reduced DMN connectivity in EOP compared to HC in the posterior cingulate cortex, precuneus, fusiform cortex, putamen, pallidum, amygdala, and insula. The subgroup analysis in the EOP group showed strongest deviations for affective psychosis, followed by other psychotic disorders and schizophrenia. There was no association between DMN connectivity strength and the current use of psychotropic medication. In conclusion, the findings demonstrate weaker DMN connectivity in adolescent patients with EOP compared to healthy peers, and differential effects across diagnostic subcategories, which may inform our understanding of underlying disease mechanisms in EOP.
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| 21. |
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| 22. |
- Johansson, Anders, et al.
(author)
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Low-flow anaesthesia with desflurane: kinetics during clinical procedures
- 2001
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In: European Journal of Anaesthesiology. - 1365-2346. ; 18:8, s. 499-504
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVE: Low-flow anaesthesia is economical and less polluting. The purpose of this study was to determine the inspired and end-tidal desflurane concentrations during anaesthesia with a vaporizer setting maintained at 5%, during low-flow anaesthesia after 120 min with fresh gas inflows of 1.0 and 2.0 L min-1. METHODS: The study was both prospective and randomized, including 56 patients (28 patients in each group) scheduled for elective surgery of an expected anaesthesia time of at least 120 min. Inspired and end-tidal concentrations of desflurane were measured during low-flow anaesthesia with fresh gas inflows of 1.0 and 2.0 L min-1. The vaporizer setting was fixed at 5% desflurane. RESULTS: The inspired and end-tidal concentrations of desflurane in the 1.0 L min-1 group after 120 min were 4.54% vs. 4.37% (P < 0.001). In the 2.0 L min-1 group, the inspired and end-tidal concentrations of desflurane were 4.76% vs. 4.58% (P < 0.001). The estimated end-tidal/inspired ratios at 120 min of anaesthesia were 0.96 in both groups. At a fresh gas flow of 1.0 L min-1, the end-tidal concentration was 0.87 of the vaporizer setting. Increasing the fresh gas flow to 2.0 L min-1 increased the end-tidal value by 0.05. CONCLUSION: There is a significant difference between the inspired and end-tidal concentrations of desflurane when fresh gas inflows were 1.0 and 2.0 L min-1, but not for the ratio of inspired/end-tidal.
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| 23. |
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| 24. |
- Johansson, Anders, et al.
(author)
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The quotient end-tidal/inspired concentration of sevoflurane in a low-flow system.
- 2002
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In: Journal of Clinical Anesthesia. - 1873-4529. ; 14:4, s. 267-270
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVE: To investigate the effect of two different fresh gas flows on inspired and end-tidal sevoflurane concentration for a given vaporizer setting in a low-flow anesthesia system.DESIGN: Prospective clinical study.SETTING: Department of Anesthesiology of a university teaching hospital.PATIENTS: 56 ASA physical status I and II patients without systemic diseases, having elective surgery with an expected anesthesia time of at least 120 minutes.INTERVENTIONS: Patients were randomly assigned to receive either 1.0 or 2.0 L/min fresh gas flow with the vaporizer setting fixed at 2% sevoflurane. The inspired (In), end-tidal (Et), and Et/In ratio sevoflurane concentrations were estimated.MEASUREMENTS AND MAIN RESULTS: After 120 minutes of sevoflurane anesthesia the inspired and end-tidal sevoflurane concentration were 1.45 +/- 0.10% versus 1.28 +/- 0.12% (p < 0.001) in the 1.0 L/min group and 1.64 +/- 0.08% versus 1.46 +/- 0.11% (p < 0.001) in the 2.0 L/min group. The ratio end-tidal and inspired concentrations/vaporizer setting was 0.64 +/- 0.06 and 0.73 +/- 0.05 in the 1.0 L/min group versus 0.73 +/- 0.05 and 0.82 +/- 0.04 in the 2.0 L/min group. For the ratio inspired and end-tidal/vaporizer setting there were significant difference between the groups (p < 0.001). The estimated ratio end-tidal/inspired was 0.88 +/- 0.04 in the 1.0 L/min group versus 0.89 +/- 0.04 in the 2.0 L/min group (ns).CONCLUSION: After 120 minutes of sevoflurane anesthesia at a vaporizer setting of 2% there is a significant difference between fresh gas flow of 1.0 and 2.0 L/min for inspired and end-tidal concentrations, but not for the ratio end-tidal/inspired.
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| 25. |
- Johansson, Eva, et al.
(author)
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Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature
- 2013
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In: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 52:5, s. 886-892
-
Research review (peer-reviewed)abstract
- Background. The use of central venous lines carries a significant risk for serious complications and high economic costs. Lately, the peripherally inserted central venous catheter (PICC) has gained in popularity due to presumed advantages over other central venous lines. The aim of this systematic literature review was to identify scientific evidence justifying the use of PICC. Material and methods. The literature review was performed according to the principles of Cochrane Collaboration. The electronic literature search included common databases up to March 2011. Only those studies rated as high or moderate quality were used for grading of evidence and conclusions. Results. The search resulted in 827 abstracts, 48 articles were read in full text, and 11 met the inclusion criteria. None of the articles was classified as high quality and two had moderate quality. The results of these two studies indicate that PICC increases the risk for deep venous thrombosis (DVT), but decreases the risk for catheter occlusion. The quality of scientific evidence behind these conclusions, however, was limited. Due to the lack of studies with sufficiently high quality, questions such as early complications, patient satisfaction and costs could not be answered. Discussion. We conclude that although PICCs are frequently used in oncology, scientific evidence supporting any advantage or disadvantage of PICC when comparing PICC with traditional central venous lines is limited, apart from a tendency towards increased risk for DVT and a decreased risk for catheter occlusion with PICC.
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| 26. |
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| 27. |
- Lodin, Karin, et al.
(author)
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Patient global assessment and inflammatory markers in patients with idiopathic inflammatory myopathies : A longitudinal study
- 2024
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In: Seminars in Arthritis & Rheumatism. - : Elsevier. - 0049-0172 .- 1532-866X. ; 65
-
Journal article (peer-reviewed)abstract
- AimTo explore if patient global assessment (PGA) is associated with inflammation over time and if associations are explained by other measures of disease activity and function in patients with idiopathic inflammatory myopathies (IIM).MethodsPGA and systemic inflammatory markers prospectively collected over five years were retrieved from the International MyoNet registry for 1200 patients with IIM. Associations between PGA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and creatine kinase (CK) were analyzed using mixed models. Mediation analysis was used to test if the association between PGA and inflammatory markers during the first year of observation could be explained by measures of disease activity and function.ResultsPGA improved, and inflammatory markers decreased during the first year of observation. In the mixed models, high levels of inflammatory markers were associated with worse PGA in both men and women across time points during five years of observation. In men, but not in women, the association between elevated ESR, CRP and poorer PGA was explained by measures of function and disease activity. With a few exceptions, the association between improved PGA and reduced inflammatory markers was partially mediated by improvements in all measures of function and disease activity.ConclusionIncreased levels of systemic inflammation are associated with poorer PGA in patients with IIM. In addition to known benefits of lowered inflammation, these findings emphasize the need to reduce systemic inflammation to improve subjective health in patients with IIM. Furthermore, the results demonstrate the importance of incorporating PGA as an outcome measure in clinical practice and clinical trials.
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| 28. |
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| 29. |
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| 30. |
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| 31. |
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| 32. |
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| 33. |
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| 34. |
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| 35. |
- Lundberg, Lena, et al.
(author)
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Effects of user charges on the use of prescription medicines in different socio-economic groups
- 1998
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In: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 44:2, s. 123-134
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Journal article (peer-reviewed)abstract
- This study examined the sensitivity towards increases in user charges for different types of drugs and among different socio-economic groups. It was based on responses by 2008 consumers of prescription drugs to a self-administered postal questionnaire sent to a random sample of 8000 inhabitants in Uppsala County in Sweden. The questionnaire included a question about whether the respondents would use fewer prescription drugs if the user charges increased by a specific amount. The increase in user charges was varied between 9 and 150% in five different subsamples. Logistic regression analysis was used to estimate the probability that a respondent would reduce consumption of prescription drugs as a function of the size of the user charges increase, socio-economic characteristics and the type of drug used. Results showed that the price sensitivity decreased with increasing age, income, education and self-rated health status. Price sensitivity was highest for antitussives and lowest for climacteric drugs. If the user charges doubled, 40% of antitussives users would reduce their consumption whereas only 11% of climacteric drugs users would reduce their consumption. It is concluded that sensitivity to increases in user charges varied greatly between different types of drugs and between socio-economic groups. The young, those with poor health status, low education and low income are most likely to decrease consumption of prescription drugs when user charges increase.
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| 36. |
- Lundberg, Owe, 1957-
(author)
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Laparoscopy and tumour growth : a clinical and experimental study
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival. Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping. Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site. Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.
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| 37. |
- Lundtoft, Christian, et al.
(author)
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Complement C4 Copy Number Variation is Linked to SSA/Ro and SSB/La Autoantibodies in Systemic Inflammatory Autoimmune Diseases
- 2022
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In: Arthritis & Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 74:8, s. 1440-1450
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Journal article (peer-reviewed)abstract
- Objective Copy number variation of the C4 complement components, C4A and C4B, has been associated with systemic inflammatory autoimmune diseases. This study was undertaken to investigate whether C4 copy number variation is connected to the autoimmune repertoire in systemic lupus erythematosus (SLE), primary Sjogrens syndrome (SS), or myositis. Methods Using targeted DNA sequencing, we determined the copy number and genetic variants of C4 in 2,290 well-characterized Scandinavian patients with SLE, primary SS, or myositis and 1,251 healthy controls. Results A prominent relationship was observed between C4A copy number and the presence of SSA/SSB autoantibodies, which was shared between the 3 diseases. The strongest association was detected in patients with autoantibodies against both SSA and SSB and 0 C4A copies when compared to healthy controls (odds ratio [OR] 18.0 [95% confidence interval (95% CI) 10.2-33.3]), whereas a weaker association was seen in patients without SSA/SSB autoantibodies (OR 3.1 [95% CI 1.7-5.5]). The copy number of C4 correlated positively with C4 plasma levels. Further, a common loss-of-function variant in C4A leading to reduced plasma C4 was more prevalent in SLE patients with a low copy number of C4A. Functionally, we showed that absence of C4A reduced the individuals capacity to deposit C4b on immune complexes. Conclusion We show that a low C4A copy number is more strongly associated with the autoantibody repertoire than with the clinically defined disease entities. These findings may have implications for understanding the etiopathogenetic mechanisms of systemic inflammatory autoimmune diseases and for patient stratification when taking the genetic profile into account.
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| 38. |
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| 39. |
- Nyholm, Dag, et al.
(author)
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Large differences in levodopa dose requirement in Parkinson's disease : men use higher doses than women
- 2010
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In: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 17:2, s. 260-266
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: The characteristics of levodopa dosing are not well described in the literature. The aims were to investigate the use of levodopa in a nationwide Swedish survey and to study the characteristics of low-dose and high-dose patients with Parkinson's disease (PD) in a university hospital. METHODS: Patients with >or= 1 and >or= 2 purchases of levodopa during 2007 were selected from the prescribed drug register. Daily levodopa doses were estimated. Records of 504 patients with PD who visited the neurology clinic at Uppsala University Hospital during 2006-2007 were examined to select a low-dose group (< or = 400 mg levodopa daily, n = 21) and a high-dose group (>or= 1200 mg daily, n = 26) with at least 5 years of PD duration. RESULTS: In total, 33 534 levodopa users with > or = 1 levodopa purchase were found. Daily levodopa dose range was large; median daily dose was 465 mg for men and 395 mg for women (P < 0.0001). Almost half (46%) of the patients used < 400 mg levodopa daily. Significantly, more men were treated with doses >or= 1200 mg daily. Dose and age correlated negatively (P < 0.0001). Patients with high dose at 5 years PD duration continuously increased their dosage the following years, whereas low-dose patients did not. The occurrence of dyskinesias was about the same in both groups despite the large difference in levodopa dose. CONCLUSIONS: We conclude that the levodopa requirement in PD ranges considerably, and that men use higher levodopa dose than women. Levodopa requirement is constant during the progression of the disease in low-dose patients but increases in high-dose patients.
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| 40. |
- Olofsson, K, et al.
(author)
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Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients
- 2004
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:6, s. 679-684
-
Journal article (peer-reviewed)abstract
- Background: Sleep disturbance is common in intensive care patients. Aside from its unpleasantness, there is a correlation with intensive care unit (ICU) syndrome/delirium. Reasons for sleep deprivation appear to be multifactorial, including the underlying illness, an acute superimposed disturbance, medications, and the ICU environment itself. There are reasons to believe that alterations of the 'biological clock' might contribute. Melatonin secretion is one reflection of this internal sleep/wake mechanism. Melatonin levels are normally high during the night and low during daytime, being suppressed by bright light. Methods: Melatonin levels in blood and urine were studied over 3 consecutive days in eight critically ill patients during deep sedation and mechanical ventilation. Sedation was assessed with the sedation-agitation (SAS) scale and bispectral index (BIS) monitor. Results: The circadian rhythm of melatonin release was abolished in all but one patient, who recovered much more quickly than the others. There was no correlation between melatonin levels and levels of sedation. Conclusions: This study indicates that dyssynchronization of the melatonin secretion rhythm is common in critically ill and mechanically ventilated patients. It could be hypothesized that an impairment of the melatonin rhythm may play a role in the development of sleep disturbances and delirium in intensive care patients, and that melatonin supply could reduce the incidence of these phenomena.
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| 41. |
- Ringdal, Mona, 1955, et al.
(author)
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Delusional memories from the intensive care unit - experienced by patients with physical trauma
- 2006
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In: Intensive and Critical Care Nursing. - 0964-3397. ; 22:6, s. 346-354
-
Journal article (peer-reviewed)abstract
- During and after intensive care unit (ICU) stays some patients report unreal experiences or so called delusional memories, which can be a source of distress. The aims of this study were: to describe trauma patients' memories of their stay in the ICU, factors that may influence delusional memories, problems experienced after discharge from the ICU and the patients' return to work. In this multi-centre study, 239 trauma patients filled in a self-administered questionnaire (ICUM tool) 6-18 months after their ICU stay. Clinical data were obtained from patient records. Fifteen percent of the respondents had no memory whatsoever of the ICU. Factual memories such as visits by family members were recalled by 83%. Delusional memories were reported by 26%, nightmares being the most common. These patients' also had more memories of pain, fear and panic. Significant factors associated with delusional memories were age <50 year, ICU stay >/=3 days, temperature >/=38 degrees C, S-Haemaglobin
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| 42. |
- Ringdal, Mona, 1955, et al.
(author)
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Outcome After Injury: Memories, Health-Related Quality of Life, Anxiety, and Symptoms of Depression After Intensive Care
- 2009
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In: Journal of Trauma-Injury Infection & Critical Care. - 0022-5282. ; 66:4, s. 1226-1233
-
Journal article (peer-reviewed)abstract
- Background: To examine the relationship between delusional memories from the Intensive Care Unit (ICU) stay, health related quality of life (HRQoL), anxiety, and symptoms of depression in patients with physical trauma, 6 months to 18 months after their ICU stay. Methods: Multicenter study in five combined medical and surgical ICUs (n = 239). A questionnaire comprising the Medical outcome Short Form 36, the Hospital Anxiety and Depression scale, and the Intensive Care Unit Memory tool was sent to the patients with trauma 6 months to 18 months after their discharge from the ICU. Clinical data were drawn from patient records in retrospect. A matched reference sample (n = 159) was randomly drawn from the Swedish Short Form 36 norm database (n = 8,930). Results: Patients with trauma had significantly lower HRQoL than the reference sample. One or more delusional memories such as hallucinations, nightmares, dreams, or sensations of people trying to hurt them in the ICU were experienced by 26%. These patients were significantly younger, had a longer ICU stay, relied more on mechanical ventilation, and had higher Injury Severity Score and Sequential Organ Failure Assessment scores. They also reported a significantly poorer HRQoL and a higher probability of experiencing anxiety (51% vs. 29%) and symptoms of depression (48% vs. 26%) compared with patients without such memories. Conclusions: Our results highlight the importance of treating the delusional memories experienced by ICU patients with a trauma diagnosis as a postinjury factor with a potential to create anxiety and symptoms of depression and which may affect HRQoL after discharge.
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| 43. |
- Rissén, Dag, et al.
(author)
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Psychophysiological stress reactions, trapezius muscle activity, and neck and shoulder pain among female cashiers before and after introduction of job rotation
- 2002
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In: Work & Stress. - : Informa UK Limited. - 0267-8373 .- 1464-5335. ; 16:2, s. 127-137
-
Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate the effects of the introduction of a job rotation model on supermarket cashiers, with respect to psychophysiological stress reactions, muscle activity of the trapezius muscle (which covers the upper back, the neck and the shoulder), and musculoskeletal symptoms in the neck and shoulders. Thirty-one female cashiers were investigated before and after job rotation was introduced. Before the reorganization the participants were only performing cash register work at the checkout counters. After the reorganization they shifted between cash register work and work in different departments in the supermarket. At follow-up the participants, all right-handed, had a significantly lower diastolic blood pressure, and surface electromyography (EMG) showed a significantly decreased muscle activity in the trapezius muscle on the left side. Musculoskeletal symptoms of the neck and shoulders were only partly changed, and there was no change in prevalence of musculoskeletal pain, which was around 70%. From questionnaires, but not from self-ratings during work, it was found that the introduction of job rotation had been experienced as positive in several regards, although the perceptions of stress and hurry were the same at follow-up.
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| 44. |
- Rissén, Dag, 1963-
(author)
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Repetitive and monotonous work among women : Psychophysiological and subjective stress reactions, muscle activity and neck and shoulder pain
- 2006
-
Doctoral thesis (other academic/artistic)abstract
- Repetitive and monotonous work is frequently associated with neck and shoulder pain and negative psychosocial factors inducing stress reactions. The present thesis concerns the relations between psychophysiological and subjective stress reactions, muscle activity measured by surface electromyography (SEMG) in the trapezius muscle, and neck and shoulder pain in women performing repetitive and monotonous work. In Study I cardiovascular and subjective stress reactions were investigated during computer work in a laboratory setting. The findings indicated that heart rate variability is a more sensitive and selective measure of mental stress compared with blood pressure recordings. Study II explored the relations between stress reactions and muscle activity during supermarket work. The results showed that perceived negative stress reactions may have a specific influence on muscle activity in the neck and shoulder region, which can be of importance for work-related musculoskeletal disorders in repetitive and monotonous work. In Study III the association between SEMG activity patterns and neck and shoulder pain was investigated during cash register work. It was found that pain-afflicted women had a different muscle activation pattern (more static, more co-contraction, less muscle rest) compared with pain-free women. Study IV was a follow-up study evaluating the introduction of job rotation among female cashiers. The results indicated positive effects on diastolic blood pressure, muscle activity, and partly on neck and shoulder pain, although perceived stress was unchanged. It was concluded that job rotation seems to have a limited effect on chronic neck and shoulder pain, but may be an effective preventive measure. The empirical findings are particularly relevant for women who, compared with men, more often perform repetitive and monotonous work and are also more often affected by neck and shoulder pain.
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| 45. |
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| 46. |
- Salmón, Pablo, et al.
(author)
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Continent-wide genomic signatures of adaptation to urbanisation in a songbird across Europe
- 2021
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In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 12
-
Journal article (peer-reviewed)abstract
- Urbanisation is increasing worldwide, and there is now ample evidence of phenotypic changes in wild organisms in response to this novel environment. Yet, the genetic changes and genomic architecture underlying these adaptations are poorly understood. Here, we genotype 192 great tits (Parus major) from nine European cities, each paired with an adjacent rural site, to address this major knowledge gap in our understanding of wildlife urban adaptation. We find that a combination of polygenic allele frequency shifts and recurrent selective sweeps are associated with the adaptation of great tits to urban environments. While haplotypes under selection are rarely shared across urban populations, selective sweeps occur within the same genes, mostly linked to neural function and development. Collectively, we show that urban adaptation in a widespread songbird occurs through unique and shared selective sweeps in a core-set of behaviour-linked genes.
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| 47. |
- Samuelson, Karin, et al.
(author)
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Intensive care sedation of mechanically ventilated patients: a national Swedish survey
- 2003
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In: Intensive and Critical Care Nursing. - 1532-4036 .- 0964-3397. ; 19:6, s. 350-362
-
Journal article (peer-reviewed)abstract
- Sedation in critically ill patients is a complex issue and at the same time an important concept for ensuring patient comfort. The aim of this study was to review the current practice of sedation for patients on mechanical ventilation in Swedish intensive care units (ICUs). Questionnaires were sent by post to head nurses in 89 ICUs with mechanically ventilated patients. By August 2000, 87 (98%) questionnaires had been returned. The results show that mechanically ventilated patients were routinely sedated in 91% of ICUs. Midazolam or propofol in combination with an opioid were the drugs preferred by 76%. Heavy sedation was most usual in 63% of ICUs but, when asked about the sedation level preferred by nurses, 78% chose light sedation (P=0.001). Only 16% used sedation scales. This study indicates that local habits and personal attitudes seem to have a great impact on sedation routines. It therefore appears worthwhile for ICUs to review their practice and, if necessary, to consider implementing sedation scales and sedation guidelines. Research pertaining to potential complications and patient comfort in relation to different sedation levels as well as further validation of the efficacy of sedation scales is needed.
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| 48. |
- Samuelson, Karin, et al.
(author)
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Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients.
- 2006
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In: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 32, s. 660-7
-
Journal article (peer-reviewed)abstract
- Objective: To investigate the relationship between memory and intensive care sedation. Design and setting: Prospective cohort study over 18 months in two general intensive care units (ICUs) in district university hospitals. Patients: 313 intubated mechanically ventilated adults admitted for more than 24 h, 250 of whom completed the study. Measurements: Patients (n = 250) were interviewed in the ward 5 days after discharge from the ICU using the ICU Memory Tool. Patient characteristics, doses of sedative and analgesic agents, and sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Results: Patients with no recall (18%) were significantly older, had higher baseline severity of illness, and experienced fewer periods of wakefulness (median proportion of MAAS score 3; 0.37 vs. 0.70) than those who had memories of the ICU (82%). Multivariate analyses showed that increasing proportion of MAAS 0-2 and older age were significantly associated with having no recall. Patients with delusional memories (34%) had significantly longer ICU stay (median 6.6 vs. 2.2 days), higher baseline severity of illness, higher proportions of MAAS scores 4-6, and more administration of midazolam than those with recall of the ICU without delusional memories. Conclusions: Heavy sedation increases the risk of having no recall, and longer ICU stay increases the risk of delusional memories. The depth of sedation during total ICU stay as recorded with the MAAS may predict the probability of having memories of the ICU.
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| 49. |
- Samuelson, Karin, et al.
(author)
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Memory in relation to intensive care sedation
- 2005
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In: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 1432-1238 .- 0342-4642. ; 31:Suppl. 1, s. 12-12
-
Conference paper (other academic/artistic)
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| 50. |
- Samuelson, Karin, et al.
(author)
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Stressful experiences in relation to depth of sedation in mechanically ventilated patients.
- 2007
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In: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 12:2, s. 93-104
-
Journal article (peer-reviewed)abstract
- n mechanically ventilated patients, sedatives and analgesics are commonly used to ensure comfort, but there is no documented knowledge about the impact of depth of sedation on patients' perception of discomfort. The aim of this study was, therefore, to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation. During 18 months, 313 intubated mechanically ventilated adults admitted to two general intensive care units (ICU) for more than 24 h were included. Patients (n= 250) were interviewed on the general ward 5 days after ICU discharge using the ICU Stressful Experiences Questionnaire. Patient data including sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Of the 206 patients with memories of the intensive care, 82% remembered at least one experience as quite a bit or extremely bothersome. Multivariate analyses showed that higher proportion of MAAS score 3 (indicating more periods of wakefulness), longer ICU stay and being admitted emergent were factors associated with remembering stressful experiences of the ICU as more bothersome. The findings indicate that the depth of sedation has an impact on patients' perception of stressful experiences and that light sedation compared with heavy seems to increase the risk of perceiving experiences in the ICU as more bothersome. In reducing discomfort, depth of sedation and patient comfort should be assessed regularly, non-pharmacological interventions taken into account and the use of sedatives and analgesics adapted to the individual requirements of the patient
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