| 1. |
- Jafari Jam, Reza, et al.
(författare)
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Template-assisted vapour-liquid-solid growth of InP nanowires on (001) InP and Si substrates
- 2020
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Ingår i: Nanoscale. - Cambridge : Royal Society of Chemistry. - 2040-3364 .- 2040-3372. ; 12:2, s. 888-894
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Tidskriftsartikel (refereegranskat)abstract
- We report on the synthesis of vertical InP nanowire arrays on (001) InP and Si substrates using template-assisted vapour-liquid-solid growth. A thick silicon oxide layer was first deposited on the substrates. The samples were then patterned by electron beam lithography and deep dry etching through the oxide layer down to the substrate surface. Gold seed particles were subsequently deposited in the holes of the pattern by the use of pulse electrodeposition. The subsequent growth of nanowires by the vapour-liquid-solid method was guided towards the [001] direction by the patterned oxide template, and displayed a high growth yield with respect to the array of holes in the template. In order to confirm the versatility and robustness of the process, we have also demonstrated guided growth of InP nanowire p-n junctions and InP/InAs/InP nanowire heterostructures on (001) InP substrates. Our results show a promising route to monolithically integrate III-V nanowire heterostructure devices with commercially viable (001) silicon platforms.
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| 2. |
- Tamás, Éva, 1968-, et al.
(författare)
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Simulation educators in clinical work : the manager's perspective
- 2020
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 34:2, s. 181-191
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Information is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers' perceptions of the significance of clinically active simulation educators for the organisation.DESIGN/METHODOLOGY/APPROACH: Healthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers' perceptions of simulation educators' impact as co-workers on their healthcare organisations.FINDINGS: The identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators' work.PRACTICAL IMPLICATIONS: The findings might have implications for the implementation and support of simulation training programs.SOCIAL IMPLICATIONS: Healthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff.ORIGINALITY/VALUE: The study provided new insights about how simulation educators as team members affect clinical practice.
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| 3. |
- Ahlberg, Hans, et al.
(författare)
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Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery : A randomised controlled trial
- 2023
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Ingår i: European Journal of Anaesthesiology. - : Wolters Kluwer. - 0265-0215 .- 1365-2346. ; 40:9, s. 636-642
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).OBJECTIVE: We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.DESIGN: A randomised controlled study.SETTING: Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.PATIENTS: Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.INTERVENTION: All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.MAIN OUTCOME MEASURE: The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.RESULTS: Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).CONCLUSION: The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03117894.
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| 4. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Cardiorespiratory response to sedative premedication in preschool children : a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine
- 2023
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 38:3, s. 454-460
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.Design: A single-center randomized controlled trial.Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.
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| 5. |
- Bromfalk, Åsa, 1967-
(författare)
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Intervention for prevention : easing children’s preoperative anxiety
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Preoperative anxiety in children is associated with several adverse outcomes and consequences that can have a negative impact on the perioperative outcome and delay recovery. Anxiety can cause stress-induced cardiorespiratory instability, increased postoperative pain, nausea, emergence delirium, and long-term behavior changes. The ideal premedication for children is still debated. Only a few studies have examined the use of premedication in relation to total intravenous anesthesia (TIVA), and there is also a lack of studies exploring staff’s experiences of premedication. The aim of this thesis was to compare midazolam (a benzodiazepine), clonidine, and dexmedetomidine (a2-agonists) given as premedication to preschool children, regarding anxiety, cardiorespiratory response to sedation, time to postoperative recovery, posthospital negative behavior changes (NBCs), and staff’s experiences of the interventions.Methods: In a randomized clinical trial, 90 children aged 2–6 years, scheduled for TIVA and ear, nose, and throat surgery, were randomized to one of three groups, receiving midazolam 0.5 mg/kg, clonidine 4 mg/kg, or dexmedetomidine 2 mg/kg. The children were included at a 200-bed county hospital in northern Sweden and observed with validated tools from the day of surgery until two weeks postoperatively (Studies I–IV). To explore the clinical aspects, we conducted focus group interviews to elicit perioperative staff’s experiences of the studied interventions and analyzed the data with qualitative content analysis (Study V). Results: Midazolam reduced preoperative anxiety and provided perioperative cardiorespiratory stability. Clonidine and dexmedetomidine provided deeper sedation along with a minor decrease in heart rate. Some children, mainly from the clonidine group, awoke during the preoperative preparation, triggering anxiety, while the midazolam group remained conscious, calm, and cooperative. Postoperatively, the midazolam group emerged earlier from anesthesia compared to the two a2-agonist groups. However, the midazolam group had more episodes of postoperative anxiety, delirium, and pain compared to both groups receiving a2-agonists, and the overall recovery and discharge time from the post-anesthesia care unit was thus the same for all groups. The posthospital study showed at least one NBC in half of the children during the first two weeks after surgery. The staff’s experiences of premedication could be summarized in three themes: a matter of time, covering the efforts of building trust along with timing the administration and onset; don’t wake the sleeping bear, covering the challenge of maintaining sleep in the sleeping child in order to avoid a backlash if woken; and on responsive tiptoes, covering safety precautions and ethical perspectives on the interventions.Conclusion: The different premedications varied in their ability to reduce anxiety and to induce sleep, and this manifested itself throughout the perioperative process. Short-acting midazolam reduced preoperative anxiety but did not provide adequate sleep, and early postoperative emergence occasionally caused a rise in adverse symptom intensification. The long-lasting and sleep-inducing a2-agonists showed an unsatisfactory anxiolytic effect in comparison to midazolam. The sleep was superficial, and an awakening risked triggering anxiety. The staff strove to keep the sedated child asleep, and the recovery time was better and more peaceful when the children slept for a long time postoperatively. However, despite a calm perioperative process, one in two children presented with posthospital NBC. At the doses used in this study, all these premedications seem to be safe in cardiorespiratory terms, and the decision of which one to use should be tailored by individual and time.
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| 6. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Perioperative staff’s experiences of premedication for children
- 2024
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers’ experiences of premedication is limited. The aim of this study was to explore perioperative staff’s experiences of premedication for preschool-age children.Design: A descriptive inductive qualitative study was performed based on focus group discussions.Methods: A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis.Findings: The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes.Conclusions: Care providers must adapt their work to the child’s emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.
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| 7. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
- 2023
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 33:11, s. 962-972
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.MethodsIn this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.ResultsAfter excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.ConclusionsNo statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.
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| 8. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Preoperative anxiety in preschool children : A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine
- 2021
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 31:11, s. 1225-1233
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.Patients and methods: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.Results: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.Conclusions: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
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| 9. |
- Carson, Dean, et al.
(författare)
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Umeå University's proposed "Rural Stream" : An effective alternative to the longitudinal integrated clerkship model for small rural communities?
- 2020
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Ingår i: Education for Health. - : Wolters Kluwer. - 1357-6283 .- 1469-5804. ; 33:1, s. 3-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Umeå University Faculty of Medicine (UUFM), Sweden, has a regionalized medical program in which students spend the final 2½ years of their undergraduate degree in district hospitals. In late 2018, UUFM started a "rural stream" pilot exposing students to smaller rural locations.Methods: The objectives are to deliver the benefits for medical education and rural workforce development that have been observed in longitudinal integrated clerkships (LICs) while maintaining consistency between learning experiences in the main campus, regional campuses, and rural locations. This article compares the UUFM rural stream with those typical of the LICs described in the medical education literature. Comparisons are made in terms of the four key criteria for LIC success, and additional characteristics including peer and interprofessional learning, "'continuity," and curriculum development.Results: The rural stream has elements of length, immersion, position in the degree program, and community engagement that are both similar to, and different from, LICs. Key challenges are to ensure that participating students create close relationships with host medical facilities and communities. The rural stream also has some potential advantages, particularly in relation to team learning.Discussion: Alternatives to the LIC rural stream model as typically described in the literature may be required to allow for immersive medical education to occur in smaller rural communities and to be suitable for medical schools with more traditional approaches to education.
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| 10. |
- Edelbring, Samuel, et al.
(författare)
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Medicinpedagogisk forskning krävs för utveckling av läkarutbildningen
- 2023
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Ingår i: Lakartidningen. - 0023-7205. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- To secure high-quality education for healthcare professionals, the teaching and learning processes-the "how" in education-should be informed by a research base. Although Swedish medical education research is growing, it lacks a national strategy. This study analysed and compared Swedish and Dutch production of medical education articles over ten years in nine core journals, including the number of editorial board members. During the period 2012-2021, Swedish authors produced 217 articles, whereas Dutch authors published 1,441. The journals had 466 board members, of which 31 (7%) were Dutch and four (<1%) Swedish. The results show that medical education in Swedish medical faculties requires improvement. To ensure high-quality education opportunities, we propose a national effort to strengthen the educational research base, using the Dutch effort as inspiration.
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| 11. |
- Edelbring, Samuel, et al.
(författare)
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Svensk medicinpedagogisk forskningsproduktion och förutsättningar för tillämpning för kvalitet och innovation
- 2023
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Beslut och metoder inom hälso- och sjukvården bygger på vetenskaplig grund vilket förutsätter en forskningsbas. Inom detta område är svensk vetenskaplig produktion och tillämpning relativt stark, däremot ser vi inte motsvarande styrka i kunskapsbasen för utbildningsuppdraget. I diskussionen om utbildningens forskningsförankring är det vanligtvis innehållet som avses eller kontakt med aktiva forskare, mer sällan hur utbildningen bör utformas för att stödja lärande eller förutsättningarna för lärarskicklighet.Det saknas inte forskning inom området, på den internationella arenan ser vi en växande högskolepedagogisk forskningsproduktion med medicin och hälsa som kontext, sk. medicinsk pedagogik. Däremot finns anledning att uppmärksamma från vilken kontext forskningen kommer och förutsättningarna att omsätta den till kvalitet och innovation i utbildningarna. Merparten av fältets forskningsproduktion kommer från USA, UK, Canada och Australien (Thomas, 2019). Den internationella prägeln på kunskapsbasen är inte alltid optimal för implementering i svenska förhållanden då resultaten och slutsatser är dragna från en kontext som i flera avseenden skiljer sig från vår. Förutom tillgång till forskning behövs möjligheter att ta del av den och omsätta till godo för utbildningen. Europeiska lärare anser inte att ny forskning når deras arbetsgrupper i någon hög utsträckning (Thomas et al., 2019). Medicinskt skolade lärare är ofta ovana vid den högskolepedagogiska forskningsgenren som evidensgrund (Kneebone, 2002). Nederländerna, som är mer befolkat än Sverige men har snarligt antal läkarutbildningar samt likartade förhållanden för högre utbildning, har satsat på en medicinpedagogisk utveckling som givit avtryck i fältet.Syftet med denna studie är att undersöka svensk forskningsproduktion inom det medicinpedagogiska området samt att föreslå en förstärkning av förutsättningar för denna produktion och dess tillämpning i utbildningar för medicin och hälsa.Metod: Författarna är pedagogiska aktörer vid tre medicinska fakulteter och har granskat svensk och nederländsk kunskapsproduktion för medicinsk pedagogik och aspekter av dess tillämpning. En bibliometrisk analys genomfördes av antal svenska och nederländska publikationer i 9 etablerade medicinpedagogiska tidskrifter för åren 1995-2021. Svenska affilieringar och finansieringskällor samt antal svenskar i tidskriftsredaktionerna analyserades också. Tidskrifterna var Medical education, Medical teacher, BMC medical education, Advances in health sciences education, Academic medicine, Perspectives on medical education, Anatomical sciences education, Teaching and learning in medicine samt International journal of medical education. Förutsättningar för forskning i medicinsk pedagogik identifierades genom sökningar på medicinska fakulteternas hemsidor samt på respektive lärosätes forskningsämnen/institutioner/forskargrupper. Resultat: Under tioårsperioden 2012–2021 publicerades 17 013 artiklar i dessa tidskrifter varav 1 441 från Nederländerna och 217 från Sverige. Nederländska publikationer ökade dramatiskt i det längre perspektivet för att plana ut till en hög produktion med 117–187 årliga publikationer under perioden, medan svenska publikationer ökade makligt till 16–33 årliga publikationer. Samtliga svenska medicinska fakulteter bidrog till produktionen, men andelen från KI dominerade. Tidskrifternas redaktioner bestod sammanlagt av 466 personer varav 31 (7%) nederländare och fyra svenskar (<1%). Organisatoriskt stöd till pedagogisk forskningsanknytning finns på alla medicinska fakulteter men i de flesta fall som en del av universitetets pedagogiska utveckling, inte anpassat till professionsutbildningar inom medicin och hälsa.Diskussion och slutsats: Forskningsbaserad kunskap bör vägleda utbildningarna, och eget forskningsengagemang i fältet skapar omdöme i utveckling och strategiska beslut. Hög forskningsproduktion är inte per se ett kvalitetsmått på utbildningarna, dock är det rimligt att anta att en satsning på produktion avspeglas i högre pedagogisk medvetenhet och säkrare beslutsunderlag i såväl fakultets- och kursledningar som hos lärare och handledare. En stark produktion och engagemang skapar delaktighet i det internationella forskarsamhället som vi både kan lära av och bidra i. Nederländerna har visat att även ett europeiskt land kan göra avtryck i fältet (Doja et al., 2014). Vi föreslår specifika svenska satsningar för en hållbar kvalitetssäkring och innovationskraft.
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| 12. |
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| 13. |
- Gottfridsson, Peter, et al.
(författare)
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Left atrial contraction strain and controlled preload alterations, a study in healthy individuals
- 2022
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Ingår i: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.METHODS: Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.RESULTS: There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s- 1 (- 1.8 to - 1.5) at baseline and - 1.8 s- 1 (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s- 1 (- 1.6 to - 1.4) at baseline and - 1.6 s- 1 (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.CONCLUSION: In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.TRIAL REGISTRATION: The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).
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| 14. |
- Gottfridsson, Peter, et al.
(författare)
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Left atrial contraction strain during a Valsalva manoeuvre : A study in healthy humans
- 2023
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Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 43:3, s. 165-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.aMETHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.
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| 15. |
- Gummesson, Christina, et al.
(författare)
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Entrustable professional activities (EPAs) for undergraduate medical education : development and exploration of social validity
- 2023
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.
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| 16. |
- Göransson, Markus Balázs, Assistant Professor, 1984-, et al.
(författare)
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‘The phone means everything.’ : Mobile phones, livelihoods and social capital among Syrian refugees in informal tented settlements in Lebanon
- 2020
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Ingår i: Migration and Development. - : Informa UK Limited. - 2163-2324 .- 2163-2332. ; 9:3, s. 331-351
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the role of mobile phones in livelihood creation among Syrian refugees in informal tented settlements in Akkar Governorate and the Bekaa Valley in Lebanon. Drawing on forty-five interviews with Syrian refugees and ten interviews with aid workers, the study highlights the importance of mobile phones in reviving, maintaining and leveraging social capital for the purpose of securing livelihoods in a context of precarity and restricted movement. We find that mobile phones offer important means for reviving social networks in exile, managing supportive relationships that have been established in Lebanon and liaising with employers. As such, they constitute important tools for coping with a context shaped by legal exclusion, restricted movement, police harassment, decentralised aid provision and a geographical dispersal of support networks, even as they remain a costly investment with uncertain returns.
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| 17. |
- Hultin, Lotta, et al.
(författare)
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Precarity, Hospitality, and the Becoming of a Subject That Matters : A Study of Syrian Refugees in Lebanese Tented Settlements
- 2022
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Ingår i: Organization Studies. - : SAGE Publications. - 0170-8406 .- 1741-3044. ; 43:5, s. 669-697
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Tidskriftsartikel (refereegranskat)abstract
- How is it possible to gain a sense that you have a voice and that your life matters when you have lost everything and live your life as a ‘displaced person’ in extreme precarity? We explore this question by examining the mundane everyday organizing practices of Syrian refugees living in tented settlements in Lebanon. Contrasting traditional empirical settings within organization studies where an already placed and mattering subject can be assumed, our context provides an opportunity to reveal how relations of recognition and mattering become constituted, and how subjects in precarious settings become enacted as such. Specifically, drawing on theories on the relational enactment of self and other, we show how material-discursive boundary-making and invitational practices – organizing a home, cooking and eating, and organizing a digital ‘home’ – function to enact relational host/guest subject positions. We also disclose how these guest/host relationalities create the conditions of possibility for the enactment of a subject that matters, and for the despair enacted in everyday precarious life to transform into ‘undefeated despair’.
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| 18. |
- Hultin, Lotta, et al.
(författare)
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The decentered translation of management ideas: Attending to the conditioning flow of everyday work practices
- 2021
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Ingår i: Human Relations. - : SAGE Publications (UK and US) / Springer Verlag (Germany). - 1741-282X .- 0018-7267. ; 74:4, s. 587-620
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Tidskriftsartikel (refereegranskat)abstract
- Based on a study of Lean management practices at the Swedish Migration Board, we develop a novel theoretical understanding of the translation of management ideas. We show how translation, rather than being reduced to a network of human intentions and actions governing the transformation of organizational practices, can instead be understood as a historically contingent, situated flow of mundane everyday work practices through which social and material translators simultaneously become translated, conditioned to be and act in certain ways. We show how prior actor-centric accounts of translation of management ideas can be understood as performative consequences of a conceptual vocabulary inherited from Callon and Latour. Contrasting this, the non-actor-centric vocabulary of social anthropologist Tim Ingold allows us to background the intentional human actor and foreground the flow of mundane, situated practices. In adopting this vocabulary, we capture how the flow of practices conditions subjects and objects to become enacted as well as act, and develop an understanding of translation as occurring within, rather than distinct from, these practices. In essence, our novel view of translation emphasizes how management ideas are radically unstable, and subject to alteration through the flow of practices rather than as a result of deliberate implementation efforts.
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| 19. |
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| 20. |
- Hultin, Magnus, 1968-, et al.
(författare)
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Hur bäst integrera KU-studenter med utländsk professionsutbildning som har svenska som andra språk?
- 2024
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Konferensbidrag (refereegranskat)abstract
- Denna workshop fokuserar på hur man bäst stöttar att personer med en utländsk professionsutbildning och som har svenska som andra språk att integreras med svenska studenter då de går en kompletterande utbildning.Problemet – integration i svenskt utbildningssystem och svensk sjukvård av studenter som behöver komplettera sin utländska utbildning och dessutom behöver det ske på ett nytt språk (svenska). En person som har en utländsk akademisk utbildning och examen kan gå en kompletterande utbildning för att få behörighet att utöva yrket i Sverige. Det gäller exempelvis lärare, socionomer, jurister och olika professioner inom hälso- och sjukvård som läkare, sjuksköterskor, tandläkare.Studenterna som går en kompletterande utbildning har vanligtvis erfarenheter från utbildningssystem som skiljer sig mycket från det svenska. De har också redan en examen från annat land, många har även lång yrkeserfarenhet. Vi tror att heterogenitet och mångfald bidrar till undervisningen på flera sätt, både teoretisk undervisning och verksamhetsförlagd utbildning, men hur gör vi på bästa sätt för att undanröja eventuella problem som kan uppstå?Under denna workshop fokuserar vi på utlandsutbildade läkare som behöver komplettera för att få arbeta som läkare i Sverige.Frågeställningar som kommer att beröras:Hur kan vi underlätta integrationen med svenska studenter under en kompletterande utbildning?Hur påverkas undervisningen när dessa studenter möter svenska studenter i klassrummen?Hur möter vi studenterna i dessa olikheter?Hur påverkas lärarna av heterogeniteten i klassrummen med äldre erfarna studenter och studenter utan yrkeserfarenhet som kommer direkt från gymnasiet?Hur hanterar handledare under verksamhetsförlagd utbildning att handleda dessa olika studenter?Hur handleder man en kollega?Hur kan vi dra nytta av heterogeniteten och mångfalden så att den bidrar till positiva värden för alla studenter som läser tillsammans?Under denna workshop kommer man gruppvis och helgrupp att diskutera:Inledande språktermin för att utveckla de utlandsutbildade kompletteringsutbildningsstudenternas svenskaIntegrerad undervisning och handledning av studenter som är skolade i vitt skilda system och som därmed har olika erfarenheter med sig i bagageStöd till studenter på kompletteringsutbildningar som läser kurser integrerat med svenska studenter och genomför praktikperioderResultatet av denna workshop kommer att kunna användas som underlag för att utveckla Kompletteringsutbildningar som baseras på Förordning (2008:1101) om högskoleutbildning som kompletterar avslutad utländsk utbildning.
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| 21. |
- Hultin, Magnus, 1968-, et al.
(författare)
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Inviting the Test Takers to Challenge the Items Might Drive Quality Improvement in National Licensing Tests for International Medical Graduates
- 2020
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Ingår i: EBMA 2020. - : The European Board of Medical Assessors (EBMA).
-
Konferensbidrag (refereegranskat)abstract
- Background International medical graduates need to show their proficiencies to obtain a medical license in a new country. In 2016 the Swedish National Board of Health and Welfare redesigned the proficiency test for Doctors of Medicine. The theoretical test consists of around 180 MCQ/SBA. All tests are made public after being used in accordance with the Swedish Public Access to Information and Secrecy Act. Thus, new tests have to be continuously developed. In addition, as a public institution, the test giver is required to reply to all challenges of the items on the test. Summary of Work To involve the stakeholders and to improve the quality of the test, the items and corresponding answer keys were made public immediately after the test was finished. The test takers were invited to challenge any item and correct answer via a web form and support challenge with literature references. The item authors then reviewed and replied to each individual challenge. Based on these challenges and the associated review, definitive answer keys were decided. Three weeks after test admission, the test takers received their results, a copy of their test together with correct answers, and the response to their challenges. Summary of Results So far, 13 different tests have been given to totally 2,328 test takers. 3,047 challenges were submitted and resulted in 87 changes in answer keys or deletions of an item from the test (3.7% of the 2,360 items across all 13 tests). The number of changes/deletions has decreased significantly with the number of developed tests. Discussion & Conclusion We consider the number of test items that have been rejected or adjusted answer keys to be low. Nevertheless, it was necessary to build a system where the challenges from the test takers were built into the test process. In the Swedish educational system appealing a grade is not possible, but if any item in a test is incorrect, the 1992 administrative law requires test givers to promptly adjust test scores. While the implemented process is resource demanding, we believe that it is crucial both for test acceptance among the examinees and to improve the skills of the item authors. Take-home Message Involving the test takers in quality assurance of a national licensing test might improve item quality.
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| 22. |
- Johansson-Jänkänpää, Emma, et al.
(författare)
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Early post-operative nausea and vomiting : A retrospective observational study of 2030 patients
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:9, s. 1229-1239
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Tidskriftsartikel (refereegranskat)abstract
- Background: The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%–40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV.Methods: This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4 hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV.Results: A total of 2030 patients were included in the study, of which 9.6% (n = 194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35 kg m−2 and major surgery and anaesthesia time ≥60 minutes.Conclusion: We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.
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| 23. |
- Jonsson, Karin, 1970-, et al.
(författare)
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Do team and task performance improve after training situation awareness? : A randomized controlled study of interprofessional intensive care teams
- 2021
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 29:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes.Method: Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2.Results: Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist.Conclusions: This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs.Trial registration: This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.
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| 24. |
- Jonsson, Karin, et al.
(författare)
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Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario
- 2020
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Ingår i: Simulation in Healthcare. - : Lippincott Williams & Wilkins. - 1559-2332 .- 1559-713X. ; 16:1, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance.METHODS: This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist.RESULTS: The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = -1.30, P = 0.02) leadership performance.CONCLUSIONS: This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.
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| 25. |
- Jonsson, Karin, 1970-
(författare)
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Knowing what’s going on : situation awareness and team performance in interprofessional teams
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Within critical care, it is necessary to have an awareness ofwhat is going on in order to be able to make the right decision at the right time.Situation awareness (SA) is a non-technical skill (NTS) that is important instressful, complex environments such as the intensive care unit (ICU).Deficiencies in NTS are well known to impact performance and thereby causeadverse events. More knowledge about how background factors are associatedto team performance and explore critical care team members experiencesteamwork are of importance to develop models for improving teamwork. Aneducational intervention aiming to improve SA during critical events might bevaluable to improve the performance of interprofessional teams. For this,instruments for assessment of SA and NTS are needed.Aim The aim of this thesis was to test different instruments for measuringSA, team performance and task performance for feasibility and reliability; to investigate the relationship between team background characteristics, teamperformance and task performance; to evaluate an educational programme inSA for intensive care teams; and to explore team members’ experience ofteamwork.Methods This thesis was based on data from 69 different video-recordedteam training sessions with a simulator as a patient (studies I–III) and ninefocus group interviews (Study IV). In Study I, the participants were 55 medicalstudents, and the sessions took place at a clinical training centre. Theparticipants in Study II (n=105) and III (n=75) were ICU staff members fromtwo different hospitals, and the sessions took place in situ at the respectiveICUs. In Study III, the participants were randomized into control orintervention group, where the intervention group received an educationalintervention comprising lectures and reflective discussions. The control grouponly performed team training without lectures and reflective discussions. Thetraining sessions were analysed with a focus on team and task performanceusing the TEAM instrument and the ABCDE checklist, respectively. Inaddition, a questionnaire (SAGAT) was used to assess individuals’ SA (StudyI and III). The data in Study I–III were quantitatively analysed. In Study IV,focus group interviews with staff members (n= 31) from the ICUs wereanalysed using qualitative content analysis.Results The findings in Study I showed that SAGAT was feasible to use andthat the inter-rater reliability for the ABCDE checklist and the TEAMinstrument indicated sufficient stability. In Study II, higher age wasassociated with several aspects of good team performance such as teamwork,task management, team overall and total team. Prior team training withoutvideo was associated with better task performance, while prior education incommunication was negatively associated with leadership. In Study III, theresults demonstrated that the educational intervention improved theperformance of the intervention group in the TEAM subscales of leadershipand task management, as well as in the total score. In Study IV, the mainfinding presented as a theme was balancing knowledge and behaviour inteamwork. The interviews revealed three categories of aspects that facilitatevor act as barriers to teamwork: (1) having potential for excellence while copingwith members who do not act as team players; (2) creating a safe atmospherewhile working in an unknown environment and struggling to maintain one’spositions; and (3) being in a workflow without becoming overwhelmed.Conclusions By implementing an educational programme focusing on SA,different parts of interprofessional team performance could be improved. Foroptimal interprofessional teamwork in the ICU, both knowledge andbehaviours were essential components. For the studies in this thesis, thedifferent instruments used were both feasible and reliable. High age wasrelated to good team and task performance, indicating that generic factors thatis associated with age might influence team and task performance.This thesis will probably contribute to a safer care of seriously ill patients at ICU.
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| 26. |
- Juto, Hans, et al.
(författare)
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Routine use of LMWH prophylaxis is associated with a lower incidence of venous thromboembolic events following an ankle fracture
- 2022
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 53:2, s. 732-738
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Tidskriftsartikel (refereegranskat)abstract
- Background: Venous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of low-molecular-weight heparin (LMWH) as prophylaxis following ankle fracture treatment. We examined the association between the incidence of VTE and the use of LMWH-prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE.Methods: In this retrospective cohort study, data on ankle fractures and fracture treatment from the Swedish Fracture Register was linked to data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Patients with VTE and patients who received LMWH prophylaxis were identified. The treating orthopedic departments were sent a questionnaire about their guidelines regarding the use of LMWH prophylaxis.Results: 222 cases of diagnosed VTE were identified among 14,954 ankle fractures. Orthopedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, CI 0.39–0.92). Among operatively treated patients, departments with a guideline for the routine use of LMWH prophylaxis also had lower incidence of VTE (OR 0.56, CI 0.37–0.86). A later onset of VTE was seen among patients prescribed LMWH prophylaxis, with a mean of 56 days to onset (CI 44–67), compared to 39 days (CI 33–45) in patients without prescribed prophylaxis. During the first two weeks following injury, there was only one case of VTE in patients with prescribed LMWH, compared to 39 cases of VTE among patients without prescribed prophylaxis.Conclusions: Routine use of LMWH in patients with operatively treated ankle fractures was associated with a lower incidence of VTE. A more frequent use of LMWH among patients with non-operatively treated ankle fractures were associated with a lower incidence of VTE. The onset occurred later among patients with LMWH-prophylaxis who still suffered a VTE.
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| 27. |
- Juto, Hans, 1975-
(författare)
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Studies of ankle fractures : classification, epidemiology, complications and results
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ankle fracture is one of the most common fractures in adult patients and is a heterogeneous group of fractures. From the fully stable fracture on the most distal part of thefibula to severely unstable and even dislocated ankles. Patients with ankle fractures often report a good result after treatment, but a small group have persistent problems.The purpose of the dissertation is to investigate classification, epidemiology, complications, and results in order to improve knowledge and management of ankle fractures.This dissertation is mainly based on data from the Swedish Fracture Register (SFR).In Study I the accuracy of the AO/OTA classification, version 2007, of ankle fractures in the SFR was examined. Entry of data into the SFR is mainly performed by the attending doctors at the accident and emergency departments, often with varying experience of fracture classification. Classification of fractures can in some cases bedifficult even for experienced orthopaedic surgeons. This is because the fractures to be categorized can be seen being on a spectrum and there will always be cases which is on the border between different categories. We created a reference group that classified several randomly selected ankle fractures from the SFR based on X-rays from treatingorthopedic departments. The assessment that was then agreed upon was considered to be the gold standard classification and could in turn be compared to the classification found in the SFR. The agreement between the classification in the SFR and the classification of the reference group was 88% for AO/OTA type level and 74% for AO/OTAgroup level. This corresponded to a kappa value of 0.77 and 0.66 respectively. The findings were equivalent to or higher than in previous studies.In study II the aim was to examine the incidence of ankle fractures in Norrbotten county, as well as the relationship between AO/OTA-classes of ankle fractures with age, gender and low-energy trauma. Ankle fractures are increasing in an ageing population but are not generally seen as a fragility fracture. All ankle fractures treated at a hospital in the county were retrospectively identified, X-rays were inspected and classified, and the medical record reviewed. The study found 1,756 ankle fractures corresponding to an incidence of 179 per 100,000 person-years. Females had an increasing incidence with age while among males the incidence was more evenly distributed. The type B fractures showed a slightly higher proportion of low-energy trauma and increased substantially with age. In contrast were the A21-subgroup and type C ankle fractures which had a lower mean age and proportion of women.Study III investigated the association between the incidence of venous thromboembolic event (VTE) and the use of low-molecular-weight heparin (LMWH) prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE. VTE is a well-known complication after ankle fracture and especially after ankle fracture surgery. The use of LMWH prophylaxis is debated. Data on ankle fracture treatment from the Swedish Fracture Register was linked to data for VTE diagnosis and LMWH prescription from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Cases of diagnosed VTE were identified among 222 of 14,954 ankle fractures. Orthopaedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, 95% CI, 0.39-0.92). Among patients treated operatively at departments with guidelines for routine use of LMWH prophylaxis there was an incidence of VTE of 1.6%, compared to 2,7% at departments without routine use of LMWH prophylaxis (OR 0.56, 95% CI, 0.37-0.86). During the first two weeks following injury, there was only one case of VTE in 5,332 patients with prescribed LMWH, compared to 39 cases of VTE among 9,622 patients without prescription.Study IV examined the variations in the length of sick leave in ankle fracture patients. Even though most patients with an ankle fracture report a satisfactory outcome there are still a number of patients with persistent pain and functional impairment. The aim of the study was to analyse how treatment, different types of ankle fracture and patients-related factors were associated with the length of sick leave by combining data from the SFR and Swedish Social Insurance Agency (SSIA). Fifty-three per cent of patients registered with an ankle fracture in the SFR had a period of paid sick leave from the SSIA. There was an association between the length of the sick leave and the severity of the fracture. A correlation was also seen between the length of the sick leave and a worse patient-reported outcome.
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| 28. |
- Karlsson, Sofia, et al.
(författare)
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Expansive Learning Process of Exercise Organizers : The Case of Major Fire Incident Exercises in Underground Mines
- 2020
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Ingår i: Sustainability. - : MDPI. - 2071-1050. ; 12:14
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Tidskriftsartikel (refereegranskat)abstract
- A major fire incident in a Swedish underground mine made the personnel from the mining company and the rescue service realize their limited preparedness. It was the beginning of a collaboration project that included the development of a new exercise model for a more effective joint rescue operation practice. The aim of this study was to explore the collaborative learning process of exercise organizers from the rescue service, mining companies, the emergency medical service, a training company, and academia. The analysis was performed through the application of the theory cycle of expansive learning to the material consisting of documents from 16 collaboration meetings and 11 full-scale exercises. The learning process started by the participants questioning the present practice of the rescue operation and analyzing it by creating a flow chart. An essential part of the process was to model new tools in order to increase the potential for collaboration. The tools were examined and tested during collaboration meetings and implemented during full-scale exercises. The exercise organizers reflected that the process led to organizational development and a better understanding of the other organizations’ perspectives. Consequently, a tentative model for developing the learning process of exercise organizers was developed.
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| 29. |
- Karlsson, Sofia, et al.
(författare)
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Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study
- 2020
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Identify factors of preparedness for peer first response to underground mining emergencies with injured victims.Design: Cross-sectional questionnaire study of Swedish underground mineworkers.Setting: Seven out of nine Swedish underground mines.Participants: A total of 741 mineworkers out of 1022 (73%) participated in this study.Interventions: None.Outcome measures: Level of preparedness for emergencies with injuries in underground mines.Results: Three factors influenced the preparedness of mineworkers for a peer first response: (1) familiarity with rescue procedures during emergencies with injuries; (2) risk perception of emergencies with injuries and (3) experience of using self-protective and first aid equipment. Mineworkers who believed that they knew how to handle emergencies with injuries (OR 1.30, 95% CI 1.22 to 1.38) and those who were trained in the use of self-protective and first aid equipment (OR 1.19, 95% CI 1.07 to 1.32) considered themselves to be better prepared for a peer first response than those who were unfamiliar with the rescue procedures or who had not used self-protective and first aid equipment. However, mineworkers who rated the risk for emergencies with injuries as high considered themselves to be less prepared than those who rated the risk as low (OR 0.95, 95% CI 0.91 to 0.98).Conclusion: This study identified three factors that were important for the peer-support preparedness of underground mineworkers. More research is needed to adapt and contextualise first aid courses to the needs of underground peer responders.
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| 30. |
- Karlsson, Sofia, 1991-
(författare)
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Saving lives during major underground mining incidents : becoming prepared for a collaborative response
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Major incidents in underground mines are uncommon, but they can have severe consequences. In Sweden, the municipal rescue service and the regional emergency medical service (EMS) are dispatched to mining incidents, and together with the privately owned/state owned mineral and metalliferous mining company they perform a rescue operation. The major fire incident of 2013 in a Swedish underground mine led to the realization that there was a general lack of preparedness for managing these underground emergencies.Aim: The overall aim was to analyze the preparedness for response to major incidents in Swedish underground mines among personnel from mining companies, the rescue service, and emergency medical service.Methods: In Study I, questionnaires (n=741) assessing Swedish underground mining company personnel’s self-assessed preparedness for emergencies were analyzed by descriptive statistics, exploratory factor analysis, and multiple logistic regression. In Study II, individual interviews with EMS personnel (n=13) were analyzed with qualitative content analysis to identify the latent content. In Study III, six focus group interviews with personnel from mining companies (n=15), the rescue service (n=9), and EMS (n=4) were analyzed with qualitative content analysis and complemented with information from ten individual interviews with EMS personnel. In Study IV, documents (n=144) from collaboration meetings and full-scale exercises were analyzed deductively using the theory of expansive learning.Results: Most of the Swedish underground mining company personnel considered themselves prepared to act in case of major incidents, and about two thirds of the mining company personnel considered themselves moderately confident that they know how to take care of a seriously injured peer. Their self-perceived preparedness was associated with their familiarity with rescue procedures, their risk perception, and their experience of using self-protective and first aid equipment (Study I). Study II showed that EMS personnel trusted the rescue service and mining company personnel to perform the rescue operation and considered themselves as having a supportive role. In Study III, the mining company, rescue service, and EMS personnel considered that because of the unfamiliar underground mining environment, they have to prepare their organizations for major underground incidents in collaboration with each other. In Study IV, a tentative model was created for the development of an expansive learning process for the organizations’ exercise organizers during a set of collaboration meetings and full-scale exercises.Conclusion: The preparedness of the mining company, rescue service, and EMS personnel was analyzed through experiences from both real events and full-scale exercises. A holistic perspective of organizational preparedness for major incidents in underground mines has been generated. All organizations have their perspective of rescue operation response, but the shared objective is to save lives and care for the injured mining company personnel by performing an effective rescue operation in collaboration.
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| 31. |
- Moraitis, Antonio, et al.
(författare)
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Palonosetron as prophylaxis for post-discharge nausea and vomiting : a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery
- 2023
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Ingår i: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients.METHODS: In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionanaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3.RESULTS: The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700).CONCLUSIONS: Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation.
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| 32. |
- Moraitis, Antonio, et al.
(författare)
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Risk of postoperative nausea and vomiting in hip and knee arthroplasty : a prospective cohort study after spinal anaesthesia including intrathecal morphine.
- 2020
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Ingår i: BMC Anesthesiology. - : BioMed Central. - 1471-2253 .- 1471-2253. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis.METHODS: The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April-November 2013 (n = 59) and September 2014-June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV.RESULTS: Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk.CONCLUSIONS: There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.
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| 33. |
- Morian, Hanna, et al.
(författare)
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Reliability and validity testing of team emergency assessment measure in a distributed team context
- 2023
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Ingår i: Frontiers in Psychology. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.
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| 34. |
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| 35. |
- Stenberg, Ylva, et al.
(författare)
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Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study
- 2022
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Ingår i: BMC Anesthesiology. - : BioMed Central. - 1471-2253 .- 1471-2253. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e’ and E/e’ for identification and grading of diastolic dysfunction pre-operatively.Methods: Ninety six ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e’-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC).Results: Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e’ and E/e’, diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e’-velocities (mean < 9 cm s− 1) had an AUROC of 0.901 (95%CI 0.840–0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78.Conclusions: The results of this study indicate that a simplified approach with tissue Doppler e’-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e’ ratio the severity of diastolic dysfunction may be overestimated.
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| 36. |
- Stenberg, Ylva, et al.
(författare)
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Pre-operative transthoracic echocardiography in ambulatory surgery : a cross sectional study
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 64:8, s. 1055-1062
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac disease and aberrations in central volume statusare risk factors for perioperative complications,and should be identified prior to surgery. This study investigatedthe benefit of transthoracic echocardiography for preoperative identification of cardiac disease andhypovolemia in ambulatory surgery.METHODS: Ninety-six patients, with a mean age of 63.5±12.2 years and body mass index of 27.0±4.3 kg/m2 , scheduled for ambulatorysurgery (breast, thyroid, minor gastrointestinal), were consecutively enrolled in this prospective observational study. Preoperative comprehensive transthoracic echocardiographywas performed in order to assess heart failure, asymptomatic left ventricular dysfunction, valvular disease and aberrations incentral volume status.RESULTS: Preoperative transthoracic echocardiography identified a total of 28 cases of heart failure; thirteen cases of heart failure with reduced, or moderately reduced, ejection fraction and fifteen cases of heart failure with preserved ejection fraction. Furthermore, forty-six cases of asymptomatic left ventricular dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia.Seven cases of previously unknown obstructive valvular or myocardial diseaseand six cases of right ventricular systolic dysfunction were identified.A total of 24% (23/96) were classified as potential critical hemodynamic findings. The number needed to treat for preoperative TTE in order to find one critical finding was 4.2.CONCLUSION: In this ambulatory surgical cohort, a high prevalence of preoperative LV dysfunction and aberrations in volume status was observed. The results demonstrate that preoperative TTE contributed valuable hemodynamic information. The standard preoperative assessment for this cohort might need to be revised.
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| 37. |
- Stenberg, Ylva, et al.
(författare)
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Preoperative Point-of-Care Assessment of Left Ventricular Systolic Dysfunction With Transthoracic Echocardiography
- 2021
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Ingår i: Anesthesia and Analgesia. - : International Anesthesia Research Society. - 0003-2999 .- 1526-7598. ; 132:3, s. 717-725
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Left ventricular (LV) systolic dysfunction is an acknowledged perioperative risk factor and should be identified before surgery. Conventional echocardiographic assessment of LV ejection fraction (LVEF) obtained by biplane LV volumes is the gold standard to detect LV systolic dysfunction. However, this modality needs extensive training and is time consuming. Hence, a feasible point-of-care screening method for this purpose is warranted. The aim of this study was to evaluate 3 point-of-care echocardiographic methods for identification of LV systolic dysfunction in comparison with biplane LVEF.METHODS: One hundred elective surgical patients, with a mean age of 63 ± 12 years and body mass index of 27 ± 4 kg/m, were consecutively enrolled in this prospective observational study. Transthoracic echocardiography was conducted 1-2 hours before surgery. LVEF was obtained by automatic two-dimensional (2D) biplane ejection fraction (EF) software. We evaluated if Tissue Doppler Imaging peak systolic myocardial velocities (TDISm), anatomic M-mode E-point septal separation (EPSS), and conventional M-mode mitral annular plane systolic excursion (MAPSE) could discriminate LV systolic dysfunction (LVEF <50%) by calculating accuracy, efficiency, correlation, positive (PPV) respective negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC) for each point-of-care method.RESULTS: LVEF<50% was identified in 22% (21 of 94) of patients. To discriminate an LVEF <50%, AUROC for TDISm (mean <8 cm/s) was 0.73 (95% confidence interval [CI], 0.62-0.84; P < .001), with a PPV of 47% and an NPV of 90%. EPSS with a cutoff value of >6 mm had an AUROC 0.89 (95% CI, 0.80-0.98; P < .001), with a PPV of 67% and an NPV of 96%. MAPSE (mean <12 mm) had an AUROC 0.80 (95% CI, 0.70-0.90; P < 0.001) with a PPV of 57% and an NPV of 98%.CONCLUSIONS: All 3 point-of-care methods performed reasonably well to discriminate patients with LVEF <50%. The clinician may choose the most suitable method according to praxis and observer experience.
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| 38. |
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| 39. |
- Stevens, Katharina, et al.
(författare)
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Low bone mineral density following gastric bypass is not explained by lifestyle and lack of exercise
- 2021
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Ingår i: BMC Surgery. - : BioMed Central (BMC). - 1471-2482. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBariatric surgery, Roux-en-Y gastric bypass (RYGBP) in particular, is associated with weight loss as well as low bone mineral density. Bone mineral density relies upon multiple factors, some of which are lifestyle factors. The aim of this study was to compare lifestyle factors in order to eliminate them as culprits of the suspected difference in BMD in RYGBP operated and controls.Materials and methodsStudy participants included 71 RYGBP-operated women (42.3 years, BMI 33.1 kg/m2) and 94 controls (32.4 years, BMI 23.9 kg/m2). Each completed a DEXA scan, as well as survey of lifestyle factors (e.g. physical activity in daily life, corticosteroid use, and calcium intake). All study participants were premenopausal Caucasian women living in the same area. Blood samples were taken in RYGBP-patients.ResultsBMD was significantly lower in RYGBP, femoral neck 0.98 vs. 1.04 g/cm2 compared to controls, despite higher BMI (present and at 20 years of age) and similar physical activity and calcium intake. In a multivariate analysis, increased time since surgery and age were negatively associated with BMD of the femoral neck and total hip in RYGBP patients.ConclusionDespite similar lifestyle, RYGBP was followed by a lower BMD compared to controls. Thus, the reduced BMD in RYGBP cannot be explained, seemingly nor prevented, by lifestyle factors. As the reduction in BMD was associated with time since surgery, strict follow-up is a lifelong necessity after bariatric surgery, and especially important in younger bariatric patients.
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| 40. |
- Thurm, Mascha, et al.
(författare)
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Spinal anaesthesia with clonidine: pain relief and earlier mobilisation after open nephrectomy – a randomised clinical trial
- 2022
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Ingår i: Journal of international medical research. - : Sage Publications. - 0300-0605 .- 1473-2300. ; 50:9, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Early mobilisation and effective pain management after open nephrectomy for renal cell carcinoma often include epidural analgesia (EDA), requiring an infusion pump and a urinary catheter, thus impeding mobilisation. Spinal anaesthesia (SpA) may be an alternative. This randomised clinical trial evaluated whether SpA improves analgesia and facilitates mobilisation over EDA and which factors influence mobilisation and length of stay (LOS).Methods: Between 2012 and 2015, 135 patients were randomised and stratified by surgical method to either SpA with clonidine or EDA. Mobility index score (MobIs), pain scale, patient satisfaction questionnaire, and LOS were the main outcome measures.Results: SpA patients exhibited an increase in MobIs significantly earlier than EDA patients. Among SpA patients >50% reached MobIs ≥13 by postoperative day 3, while 29% of EDA patients never reached MobIs ≥13 before discharge. SpA patients had higher maximum pain scores on postoperative days 1 and 2, but both groups had similar patient satisfaction. One day before discharge, 36/64 SpA versus 22/67 EDA patients (56% and 33%, respectively) were opioid-free. SpA patients were discharged significantly earlier than EDA patients.Conclusions: SpA facilitates postoperative pain management and is associated with faster mobilisation and shorter LOS.The trial was registered at ClinicalTrials.org (ID-NCT02030717).
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| 41. |
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| 42. |
- Zickerman, Caroline, et al.
(författare)
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Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children
- 2023
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 67:6, s. 706-713
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anesthesia preinduction anxiety in children can according to some studies lead to long-term anxiety and negative behavioral changes (NBC), while other studies have not found this effect. This secondary analysis from a recent premedication trial comparing clonidine and midazolam aimed to test the relation between preoperative anxiety assessed with modified Yale Preoperative Anxiety Scale (mYPAS) and postoperative NBCs assessed with Post Hospital Behavior Questionnaire (PHBQ), regardless of premedication type.Methods: This is a planned secondary analysis from a published premedication comparison trial in an outpatient surgery cohort, children aged 2–7 years. Participant and preoperative factors, particularly preoperative anxiety as mYPAS scores, were assessed for association with development of postoperative NBCs.Results: Fifty-four of the 115 participants had high preinduction anxiety (mYPAS >30), and 19 of 115 developed >3 postoperative NBCs 1 week after surgery. There was no association between preinduction anxiety level as mYPAS scores and the development of postoperative NBCs at 1 week after surgery (10 of 19 had both, p =.62) nor after 4- or 26-weeks post-surgery. Only lower age was associated with development of NBCs postoperatively.Conclusions: Based on the findings from this cohort, high preinduction anxiety does not appear to be associated with NBCs postoperatively in children premedicated with clonidine or midazolam.
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