| 1. |
- Hollman, Gunilla, 1953-, et al.
(författare)
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Quality of life in patients with familial hypercholesterolaemia
- 2002
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 251:4, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The primary aim of this study was to analyse quality of life in adult patients with familial hypercholesterolaemia (FH), a genetic disorder with increased risk of coronary heart disease (CHD). Secondary aims were to find explanatory factors for quality of life and anxiety.Design. A descriptive cross-sectional design was used.Setting. Outpatients from lipid clinics at two university hospitals in Sweden were included. Patients with heterozygous FH and a randomly selected control group participated by filling out questionnaires.Subjects. Two hundred and eighty patients with heterozygous FH above 18 years of age were asked, and 212 of whom 185 were free of overt CHD, participated. Of a control group of 2980 persons 1485 were included for comparison.Methods. We used Likert-type questionnaires: the Quality of Life Index (QLI) consisting of four subscales, the Hospital Anxiety and Depression Scale (HAD), the Mastery Scale measuring coping and a questionnaire on health and lipids constructed for FH patients.Results. Patients with FH were significantly more satisfied with overall quality of life 21.8 ± 0.3 (SEM) vs. controls 21.1 ± 0.1 and this was also the case in three of four subscales, all differences P < 0.05. Anxiety about getting CHD was expressed amongst 86% of the patients with FH.Conclusions. Quality of life amongst patients with FH was at least as good as in controls but they were worried about getting CHD.
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| 4. |
- Angelin, Bo, et al.
(författare)
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Reductions in serum levels of LDL cholesterol, apolipoprotein B, triglycerides and lipoprotein(a) in hypercholesterolaemic patients treated with the liver-selective thyroid hormone receptor agonist eprotirome
- 2015
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Ingår i: Journal of Internal Medicine. - : Wiley: 12 months. - 0954-6820 .- 1365-2796. ; 277:3, s. 331-342
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLiver-selective thyromimetic agents could provide a new approach for treating dyslipidaemia. MethodsWe performed a multicentre, randomized, placebo-controlled, double-blind study to evaluate the efficacy and safety of eprotirome, a liver-selective thyroid hormone receptor agonist, in 98 patients with primary hypercholesterolaemia. After previous drug wash-out and dietary run-in, patients received 100 or 200gday(-1) eprotirome or placebo for 12weeks. The primary end-point was change in serum LDL cholesterol; secondary end-points included changes in other lipid parameters and safety measures. ResultsEprotirome treatment at 100 and 200g daily reduced serum LDL cholesterol levels by 235% and 31 +/- 4%, respectively, compared with 2 +/- 6% for placebo (Pless than0.0001). Similar reductions were seen in non-HDL cholesterol and apolipoprotein (apo) B, whereas serum levels of HDL cholesterol and apo A-I were unchanged. There were also considerable reductions in serum triglycerides and lipoprotein(a), in particular in patients with elevated levels at baseline. There was no evidence of adverse effects on heart or bone and no changes in serum thyrotropin or triiodothyronine, although the thyroxine level decreased. Low-grade increases in liver enzymes were evident in most patients. ConclusionIn hypercholesterolaemic patients, the liver-selective thyromimetic eprotirome decreased serum levels of atherogenic lipoproteins without signs of extra-hepatic side effects. Selective stimulation of hepatic thyroid hormone receptors may be an attractive way to modulate lipid metabolism in hyperlipidaemia.
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| 5. |
- Arribas, Christina, et al.
(författare)
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Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools : impact of the sociodemographic index (SDI)
- 2024
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Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447.
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.Methods: This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.Results: The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.Conclusions: Socio-economic status of countries impacts on neonatal analgosedation management.
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| 6. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Balancing power by including parents as co-researchers : Live parental singing, breastfeeding, skin-to-skin-contact as procedural support in Swedish neonatal pain care
- 2022
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Konferensbidrag (refereegranskat)abstract
- Frequent and inadequately treated pain combined with separation from the parent cause adverse interruptions to the parent-infant attachment process. The pain might harm the infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. Effective pain management strategies are needed and parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Important for translating research into practice is to involve healthcare professionals and parents as co-researchers. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. The Nordic neonatal music therapy pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in interdisciplinary neonatal pain research. Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-centre clinical study with mixed methods. The collaborative participatory action research design for the qualitative part of the SWEpap study aims to democratise the research process involving both parents and health professionals in the knowledge-making. The second part of SWEpap is a randomised controlled trial informed by music therapy expertise and research using the Nordic neonatal music therapy pain management strategy as a theoretical framework for its design. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine metabolic screening of newborn infants.
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| 7. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP) : protocol for a randomised controlled trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Preterm infants are at risk of negative consequences from stress and pain at the same time as they often are in need of intensive care that includes painful interventions. One of the frequent painful procedures preterm infants undergo is eye examination screening to detect early signs of ROP (retinopathy of prematurity). These examinations are both stressful and painful, and despite a multitude of research studies, no conclusive pain-relieving treatment has been demonstrated. The main aim of this trial is to investigate the analgesic effect of clonidine during ROP eye examinations.Methods and analysis The planned study is a multicentre randomised controlled trial with a crossover design. Infants will be recruited from two different neonatal intensive care units (NICUs) in Sweden. Infants born before gestation week 30 (and therefore eligible for ROP screening) and cared for in either of the NICUs will be eligible for inclusion in the study. The primary outcome will be Premature Infant Pain Profile–Revised score within 30 s after starting the examination. Secondary outcomes will be changes in the galvanic skin response parameters (area small peaks, area huge peaks, peaks per second and average rise time) within 30 s after starting the eye examination, together with the number and evaluation of adverse events reported within 72 hours after the examination and the examining physician’s assessment of how easy the infant was to examine.Ethics and dissemination Approval from the Swedish Ethical Review Authority and the Swedish Medical Products Agency has been obtained for the study. Parents of eligible infants will be getting both verbal and written information about the study including that participation is voluntary. Data will be collected and treated in accordance with the European general data protection regulations. The results will be reported on group level and published in a scientific journal.
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| 8. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants -cloROP
- 2024
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Konferensbidrag (refereegranskat)abstract
- BackgroundPreterm infants are vulnerable and sensitive to stimuli, during their stay in neonatal intensive care they undergo frequent stressful and painful procedures. One of these painful procedures is the screening for retinopathy of prematurity, ROP. In Sweden all preterm infants born before gestation week 30 undergo ROP-screening. The screening involves regular eye examinations to detect ROP at the early stages and these examinations are both stressful and painful. Several studies have investigated different ways of pain management during eye examinations with inconsequent results. No study has investigated Clonidine as pain management during ROP-screening. AimThe aim of this clinical trial is to investigate the analgesic effect of clonidine during ROP eyeexaminations.MethodThis study is a multicenter randomized controlled clinical trial with a crossover design. Infants born before gestation week 30 and therefore undergoing ROP-screening, will be eligible for inclusion in the study. Infants will be recruited from two Swedish NICUs (neonatal intensive care units). The NICUs use different examination techniques, where NICU A uses indirect ophthalmoscopy while NICU B uses RetCam. A total of 50 infants will be recruited (25 at each NICU). During the first eye examination the infant will be randomized to either clonidine 4mcg/kg or sterile water in the equivalent dose 60 minutes before the eye examination. The order of the treatment is blinded for everyone except the nurse preparing the study solution. During the second eye examination the infant will receive the study solution, (intervention or placebo) that he/she did not receive the first time. The primary outcome of the study is pain assessment with the Premature Infant Pain Profile – Revised. The infants´ face and monitor showing oxygen saturation and heart rate will be videorecorded to be able to assess the pain afterwards. The secondary outcome is Galvanic Skin Response where three probes are attached to the infant’s foot sole to register changes in the sweat gland activity in response to stimuli such as pain or stress. The ophthalmologist performing the eye examination will also rate how easy it was to examine the infant by marking an X on a 10cm VAS scale with “very easy to examine” on one end and “very difficult to examine” on the other end. Data collection is ongoing with 19 infants included at the moment.
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| 9. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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“Having my boy on my chest, humming to him, made us both very calm.” : Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background:Parents are a valuable but underutilized resource in procedural pain management in newborn infants. Parents want to take an active role in their infants’ pain management. Yet, there is a lack of knowledge concerning the parents’ experiences of providing pain management. Newborn infants experience several painful procedures related to postnatal care and immunizations. Not all infants receive adequate pain management during these procedures causing unnecessary suffering and leaves the infant at risk of complications. Parent-delivered pain management such as skin to skin contact and breastfeeding alleviate the infant’s pain during painful procedures. Live parental infant-directed lullaby singing has not been previously investigated during painful procedures. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Parents have a unique expertise about their infants and by including them in the pain management they could become valuable partners for the health professionals. The aim of the study was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant. Method: This study was part of a multi-center randomized controlled trial (RCT) with three parallel groups of healthy newborn infants and their parents. The SWEpap study (Parents as pain management in Swedish neonatal care), investigates the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, and compared with just holding skin-to-skin during routine metabolic screening of newborn infants. The infant-parent dyads were randomly assigned to one of three treatment groups. For the parents’ ratings of meaningfulness, a visual analogue scale (VAS) with a 100mm line anchored at the ends is used; from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to give their verbal comment on how they experienced the blood sampling situation and providing pain management. Results: A total number of 151 newborn infants with at least one parent, participated in the study. Mean gestational age was 39.6 w., mean birth weight was 3547 g., and 49,7 % were girls. The mean VAS-ratings for meaningfulness were 82.1 in the standard care group, 89.5 in the skin-to-skin group and 88.9 in the combined intervention group. The ratings in the two groups with parent-delivered pain-alleviation were significantly higher than in the standard care group (p=0.036). Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant. “Very meaningful. It felt much safer to have her close to me during the skin puncture. Usually, she is on the examination table which gives an unsecure feeling because when she is in pain you can’t do anything as a parent.” (Mother, skin-to-skin group) “It felt very good to make a positive impact. Singing went very well. I usually sing all the time at home.” (Father, combined group) “I could control the syringe with glucose which made me less helpless as a parent because I could contribute.” (Parent, standard care group) Some parents commented that providing pain management helped themselves to overcome their own fears. “I am scared of needles myself and has been worrying about needles and blood but this went really well. She was so calm, gave not a sound. I could also relax when she was calm.” (Mother, skin-to-skin group) Parents also compared with previous blood sampling situations. “My previous child was totally hysteric during blood sampling on the examination table. Today, the baby was absolutely calm.” (Parent, combined group) Finally, many parents expressed that they wanted to continue providing parent-delivered pain management in the future. “I can absolutely think to use this pain relief combination in the future. He does recognize the singing and my voice from before.” (Mother, combined group) Conclusions: The findings of this study shows that parents find it meaningful to provide parent-delivered pain-alleviating interventions during painful procedures in postnatal care. The parents in the skin-to-skin group and the group that combined skin-to-skin, breastfeeding, and live parental lullaby singing expressed that they wanted to keep using these methods in future painful situations as well. Even parents with fear of needles felt it was meaningful to participate in parent-delivered pain-alleviating pain management since their participation blunted their own fear. Relevance for patient care: All newborn infants are subjected to painful procedures during the first months of life and pain-relieving methods are insufficiently used. Modern neonatal care strives to be family oriented with a high degree of parental participation. This must also be the case with pain management and parents must be given tools and opportunities to be an active agent in their infant’s pain management.
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| 10. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Nurses' perception, knowledge, and use of neonatal pain assessment
- 2021
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Ingår i: Paediatric and Neonatal Pain. - : John Wiley & Sons. - 2379-5824 .- 2637-3807. ; 3:2, s. 68-74
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Tidskriftsartikel (refereegranskat)abstract
- Preterm and sick newborn infants undergo several painful procedures during their hospital stay, potentially leading to short‐ and long‐term negative consequences. Pain assessment should be performed regularly to provide optimal pain management. Nurses' knowledge of and attitude toward neonatal pain assessment affect how pain is assessed and managed in the clinical situation. The aim of this study was to explore Swedish nurses' perception, knowledge, and use of neonatal pain assessment. This descriptive, cross‐sectional questionnaire study was conducted across all Swedish neonatal units (n = 38). Respondents were chosen through convenience sampling by the head nurses at each unit. Ten nurses from each unit were asked to complete the survey, which contained both closed and open questions. A majority of the units (30/38; 79%) participated and 232 surveys were returned, a response rate of 61%. Of the nurses, 91% thought that neonatal pain assessment was important. Many nurses mentioned various difficulties with pain assessment and concerns that the scales used might not assess pain correctly. About half of the nurses considered themselves to have enough knowledge of neonatal pain assessment. Those who reported having enough knowledge of pain assessment viewed the pain scales used at their units more positively. Of the nurses, 74% reported using a pain assessment scale several times per work shift. Pain management guidelines were available according to 75% of nurses, but only 53% reported that the guidelines were followed. Although nurses in general expressed a positive attitude toward pain assessment scales, this was not necessarily evident in their clinical practice. Lack of knowledge, available or accessible guidelines, or concerns regarding the validity of available pain scales seemed to limit their use.
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