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- Arrillaga-Romany, Isabel, et al.
(author)
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Performance of a Hospital Pathway for Patients With a New Single Brain Mass
- 2019
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In: JOURNAL OF ONCOLOGY PRACTICE. - : American Society of Clinical Oncology (ASCO). - 1554-7477. ; 15:3, s. e211-e218
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Journal article (peer-reviewed)abstract
- WHAT WE FOUND:Length of stay and time to surgery were significantly reduced after implementation of this admission pathway. Readmission rate was not adversely affected by this change. The protocol also significantly reduced the number of unnecessary body computed tomography imaging studies obtained in this patient population.CONFOUNDING FACTORS/REAL-LIFE IMPLICATIONS:The results of this study should be interpreted with their retrospective nature in mind. Further, analysis of this admission pathway did not take into consideration patient perspective or cost implications. Finally, the authors recognize that the resources for such an operational shift may only be found in large, tertiary, referral centers.Optimized specialized care for patients with new single brain masses promotes improved health care outcomes. It may also predictively reduce health care costs and improve patient satisfaction. More research is needed in this field. Limitations to our study included the inherent limitations of a retrospective pre-post design that can make it difficult to separate the effect of a specific intervention from other factors that change over time. In addition, assessment of patient satisfaction, use of diagnostic tests beyond body imaging, and advanced cost analysis could have strengthened this study. Lastly, it should be noted that the applicability of our approach may be limited to major tertiary centers with enough resources to implement such a pathway.Purpose:To reduce care variation and improve the management of patients with newly identified single brain masses and no history of cancer, we implemented a dedicated admission protocol.Methods:We reviewed records of 206 patients who presented to our emergency department between January 2010 and May 2016 with a new single brain mass but no history of cancer. Patients admitted before the protocol implementation were designated the pre-implementation group (PRE), and those admitted after implementation were designated the post-implementation group (POST).Results:Ninety-six patients were in the PRE group and 110 in the POST group. Length of stay for POST patients was significantly shorter than for PRE patients (6 v 7 days, respectively; P = .042), and this effect was more robust after excluding the 66 patients who were discharged to rehabilitation, skilled nursing, or hospice facilities (5 v 7 days, respectively; P = .001). Additional comparison of POST with PRE patients showed that time to surgery was significantly reduced (2.7 v 3.5 days, respectively; P = .006) and that computed tomography scans of the chest, abdomen, and pelvis were reduced (12% v 47%, respectively; P < .001). No difference was found in the 30-day readmission rates. For patients with GBM, there also was no significant difference in time to initiation of chemoradiation or in median overall survival.Conclusion:Implementation of a specialized admission pathway for patients with a new single brain mass decreased average length of hospital stay and time to surgery and reduced unnecessary diagnostic imaging tests in patients with primary brain tumors.
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| 4. |
- Hellstrand, Per, et al.
(author)
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Effects of nine different gastrointestinal polypeptides on vascular smooth muscle in vitro
- 1980
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In: Acta Physiologica Scandinavica. - 0001-6772. ; 110:1, s. 89-94
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Journal article (peer-reviewed)abstract
- Nine polypeptides of gastrointestinal origin were tested for their possible effect on vascular smooth muscle of the rat portal vein. The substances tested were bombesin, caerulein, glucagon, insulin, pentagastrin, secretin, somatostatin, substance P and vasoactive intestinal polypeptide (VIP). Cumulative dose-response relations of integrated mechanical activity (mean tension) were obtained with maximal concentrations of the various peptides of 1-10 microgram/ml. Within this concentration range, only substance P and VIP showed clearcut effects; substance P causing contraction and VIP relaxation. The dose of substance P needed to produce contraction was high (ED50 greater than 1 microM) so that the physiological importance of this response is doubtful. On the other hand, ED50 for the relaxing effect of VIP was about 15 nM, which is in accordance with concentrations reported to produce significant vasodilatation in vivo. The results support the view that vascular effects which have been reported to occur in response to the other 7 peptides are mainly of indirect origin and not mediated via direct action on vascular smooth muscle.
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| 5. |
- Hellstrand, Per, et al.
(author)
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Role of vasoactive intestinal polypeptide (VIP) in the neurogenic vasodilatation of the portal vein in the rabbit
- 1985
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In: Regulatory Peptides. - : Elsevier BV. - 1873-1686 .- 0167-0115. ; 12:4, s. 309-316
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Journal article (peer-reviewed)abstract
- A coarse network of nerve fibres displaying immunoreactivity for vasoactive intestinal polypeptide (VIP) was found in the wall of the hepatic portal vein of the rabbit. Electrical field stimulation of the rabbit portal vein in vitro, in the presence of adrenergic and cholinergic blockade, caused a marked relaxation of the vessel and a release of VIP into the perfusate. Addition of VIP to the tissue bath elicited a concentration-dependent inhibition of the mechanical activity of the portal vein. The results suggest that VIP containing neurones might participate in the non-cholinergic, non-adrenergic vasodilatation of the portal vein in the rabbit.
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- Järhult, Johannes, et al.
(author)
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Long-term results of surgery for lithium-associated hyperparathyroidism.
- 2010
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In: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 97:11, s. 1680-5
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Journal article (peer-reviewed)abstract
- Lithium therapy for affective bipolar disease is frequently associated with hyperparathyroidism (HPT), but the results of surgical treatment are virtually unknown. The aim of this retrospective review was to analyse the long-term outcome after surgery for lithium-induced HPT in a large series of patients.
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| 7. |
- Järhult, J, et al.
(author)
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Outcome of hypocalcaemia after thyroidectomy treated only in symptomatic patients
- 2016
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In: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 103:6, s. 676-683
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Journal article (peer-reviewed)abstract
- Background: Calcium supplementation has been proposed after bilateral thyroid surgery, either to all patients or to those with biochemical hypocalcaemia. It has also been suggested that supplementation aids parathyroid recovery and prevents permanent hypoparathyroidism. This single-centre study investigated the feasibility of a restrictive management of post-thyroidectomy hypocalcaemia.Methods: Serum calcium was checked before surgery, on postoperative day 1 (POD) 1, at a follow-up visit 6-8 weeks after surgery and after a minimum of 12 months in all patients. Regardless of serum calcium levels, patients with symptoms of hypocalcaemia were prescribed oral calcium supplementation (0·5-1·0 g twice daily) and asymptomatic patients were not. Asymptomatic patients were informed about hypocalcaemic symptoms and instructed to contact the surgical ward should symptoms appear.Results: Some 640 patients underwent bilateral thyroid surgery without previous or intentional simultaneous parathyroidectomy. A subnormal serum calcium level (below 2·15 mmol/l) was observed in 412 patients (64·4 per cent) on POD 1. By comparison, only 63 patients (9·8 per cent) experienced symptoms of hypocalcaemia in the postoperative period, all but one with a corresponding biochemical hypocalcaemia on POD 1. Calcium levels in all patients with asymptomatic postoperative hypocalcaemia recovered to normal without supplementation. Serum calcium was also normalized during follow-up in all symptomatic patients, except 22 (3·4 per cent) who became permanently hypoparathyroid. No patient without early hypocalcaemic symptoms developed permanent hypoparathyroidism.Conclusion: The proposed restrictive management of postoperative hypocalcaemia after bilateral thyroid surgery avoids unnecessary supplementation for most patients.
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- Järhult, Susann J., et al.
(author)
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Brachial artery hyperaemic blood flow velocity and left ventricular geometry
- 2012
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 26:4, s. 242-246
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Journal article (peer-reviewed)abstract
- Cardiovascular risk factors and carotid atherosclerosis relate to blood flow velocity in the brachial artery during induced hyperaemia. This relation proved to be particularly strong when using the hyperaemic systolic to diastolic blood flow velocity (SDFV) ratio. In this study, we further investigated this ratio in relation to the left ventricular (LV) geometry in a cross-sectional analysis. In the Prospective Investigation of the Vasculature in Uppsala Seniors study, 1016 seventy-year-olds participated. Blood flow velocity during hyperaemia of the brachial artery by Doppler was analysed. Echocardiography was performed, allowing analysis of LV geometry, categorised into four different groups: normal, concentric remodelling, concentric and eccentric hypertrophy. The SDFV ratio increased in subjects with concentric LV-remodelling (P 0.006) or LV-hypertrophy (P=0.001), but not in those with eccentric hypertrophy (P=0.12) when compared with the group with normal LV geometry. These associations remained significant after adjustment for gender, blood pressure, blood glucose, body mass index and antihypertensive treatment. The SDFV ratio in the brachial artery was related to concentric geometry of the LV in an elderly population sample, suggesting this new hemodynamic variable as a marker of increased afterload. Future studies have to determine if the SDFV ratio is a powerful predictor of future CV events, in addition to LV geometry.
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| 10. |
- Järhult, Susann J., 1971-, et al.
(author)
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Brachial artery hyperemic blood flow velocities are related to carotid atherosclerosis
- 2009
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In: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 29:5, s. 360-365
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Cardiovascular (CV) risk relates to the blood flow velocity pattern in the brachial artery during hyperemia, especially to the hyperaemic systolic to diastolic mean blood flow velocity (SDFV) ratio. Here, we investigated the relations between SDFV in the brachial artery and different characteristics of carotid atherosclerosis. MATERIAL AND METHODS: Data were collected from 1016 70-year-olds participating in the Prospective Investigation of Uppsala Seniors study. Doppler recordings of blood flow velocity during hyperemia were analysed in the brachial artery. In the carotid artery, intima-media thickness (IMT) was recorded together with an assessment of echogenicity by the Grey scale median (GSM) method in both overt plaques and in the intima-media complex (IM-GSM). RESULTS: The SDFV ratio was related to the number of carotid arteries affected by plaque (P = 0.018) and inversely to plaque echogenicity (P = 0.0003). The SDFV ratio was also related to IMT (P = 0.0022) and inversely to IM-GSM (P = 0.0001). These relations were statistically significant also after adjusting for major CV risk factors, individually as well as summarised as the Framingham risk score. CONCLUSION: Our results indicate that the hyperemic systolic to diastolic blood flow velocity ratio in the brachial artery is related to atherosclerosis in the carotid artery.
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