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- Jung, Christian, et al.
(författare)
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A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
- 2019
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Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 52, s. 141-148
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
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| 3. |
- Stojanovski, Todor
(författare)
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Urban Form and Mobility - Analysis and Information to Catalyse Sustainable Development
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urban transportation today consumes scarce resources of fossil fuels and it is a major cause for environmental damage and accelerating climate change. To achieve sustainable mobility in the cities, it is necessary to improve energy efficiency and lower carbon emissions through the promotion of walking, cycling and especially public transportation.The urban form and the embeddedness of automobility is a challenging obstacle on the way towards sustainable mobility and cities. Many neighbourhoods and cities, particularly in developed countries like Sweden, were specifically designed and developed to accommodate the private car, individual mobility and freedom of movement. It is impossible to walk or cycle and the public transportation is not competitive. The lack of mobility choices in these neighbourhoods and cities hinders the possibilities to shift towards more sustainable travel alternatives. Urban designers and planners can help with redesigning these neighbourhoods and creating urban forms that encourage walking, cycling and increased use of public transportation if they are aware about the possible modal shares, energy efficiency, environmental performance and carbon implications of transportation in existing and newly planned neighbourhoods.This Doctoral Thesis examines Swedish urbanisation and the historical integration of public transportation in competition with other transportation modes. It analyses emergence of typical neighbourhoods that oriented towards walking (the pre-industrial city), to public transportation (the industrializing city), to the private automobile (the modern/industrial city) and ultimately to a wide range of mobility choices (the postmodern/post-industrial city with sustainable city neighbourhoods). It investigates furthermore the effect of urban form variables (including neighbourhood type) on travel (modal shares of public transportation). Based upon this empirical knowledge, the Doctoral Thesis proposes a mobility choices model based on urban form and accessibility factors commonly used in urban planning, design and development practices. The mobility choices model produces heat maps and visually informs about the integration with walking, cycling, public transportation and private car, modal shares, carbon emissions and transportation energy use. This information can (potentially) trigger urban transformation or redesign car-oriented neighbourhoods to better integrate energy efficient and environmentally friendly mobility alternatives and catalyse the development of more sustainable cities.
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