| 1. |
- Ackermann, Paul W, et al.
(författare)
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Reduced time to surgery improves patient-reported outcome after achilles tendon rupture
- 2018
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Ingår i: The American Journal of Sports Medicine. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0363-5465 .- 1552-3365.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols, however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred and twenty-eight ATR patients treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on a free slot in the operating theatre and neither surgeon nor patient could affect TTS. Patients were assigned into three groups according to trichotomized TTS; short- (<48hours), intermediate- (48-72hours) and long TTS (>72hours). Patient-reported outcome at one-year was assessed using the validated Achilles tendon Total Rupture Score, with scores>80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (peri- and postoperative) and deep venous thrombosis were assessed. Results: Shorter TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared to 44% (95% CI, 33%-56%) of the patients 3 with long TTS (p=.002), and with the intermediate TTS group in between (63%, 95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS 1.4% (95% CI, 1%-4%) as compared to those with intermediate TTS 11% (95% CI, 2%-21%) (p=.035) and to patients with long TTS 14.8% (95% CI, 7%-23%) (p=.003). The risk of sustaining a deep venous thrombosis was not statistically significant different among the three groups (p=.15). Conclusion: Patients with acute ATR operated on within 48 hours after injury yielded better outcomes and a lower number of adverse events compared to patients operated on after 72 hours. These results conform to evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols.
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| 2. |
- Sandström, Robin, 1988-
(författare)
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Innovations in nanomaterials for proton exchange membrane fuel cells
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hydrogen technologies are rapidly receiving increased attention as it offers a renewable energy alternative to the current petroleum-based fuel infrastructure, considering that continued large-scale use of such fossil fuels will lead to disastrous impacts on our environment. The proton exchange membrane fuel cell should play a significant role in a hydrogen economy since it enables convenient and direct conversion of hydrogen into electricity, thus allowing the use of hydrogen in applications particularly suited for the transportation industry. To fully realize this, multiple engineering challenges as well as development of advanced nanomaterials must however be addressed.In this thesis, we present discoveries of new innovative nanomaterials for proton exchange membrane fuel cells by targeting the entire membrane electrode assembly. Conceptually, we first propose new fabrication techniques of gas diffusion electrodes based on helical carbon nanofibers, where an enhanced three-phase boundary was noted in particular for hierarchical structures. The cathode catalyst, responsible for facilitating the sluggish oxygen reduction reaction, was further improved by the synthesis of platinum-based nanoparticles with an incorporated secondary metal (iron, yttrium and cobalt). Here, both solvothermal and high-temperature microwave syntheses were employed. Catalytic activities were improved compared to pure platinum and could be attributed to favorably shifted oxygen adsorption energies as a result of successful incorporation of the non-precious metal. As best exemplified by platinum-iron nanoparticles, the oxygen reduction reaction was highly sensitive to both metal composition and the type of crystal structure. Finally, a proton exchange membrane based on fluorine and sulfonic acid functionalized graphene oxide was prepared and tested in hydrogen fuel cell conditions, showing improvements such as lowered hydrogen permeation and better structural stability. Consequently, we have demonstrated that there is room for improvement of multiple components, suggesting that more powerful fuel cells can likely be anticipated in the future.
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| 3. |
- Westman, Jeanette, et al.
(författare)
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Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)
- 2019
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 208, s. 138-144
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Tidskriftsartikel (refereegranskat)abstract
- Background: Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. Aim: Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. Methods: A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and the control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. Results: The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. Conclusion: The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors.
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