| 1. |
- Febring, Linda, et al.
(author)
-
Pedagogisk design
- 2020
-
Conference paper (other academic/artistic)
|
|
| 2. |
|
|
| 3. |
- Lindholm, Maj-Lis, et al.
(author)
-
Cumulated Time With Low Bispectral Index Values Is Not Related to the Risk of New Cancer or Death Within 5 Years After Surgery in Patients With Previous or Prevailing Malignancy
- 2014
-
In: Anesthesia and Analgesia. - : Lippincott Williams & Wilkins. - 0003-2999 .- 1526-7598. ; 118:4, s. 782-787
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Preclinical data indicate that anesthesia and surgery may promote cancer growth. We previously found no increased risk of malignant disease within 5 years regarding duration of general anesthesia (T-ANESTH) and time with Bispectral Index (BIS) under 45 (T-BIS less than 45) in patients without any diagnosis or history of malignancy before or within 1 month after surgery. Because immunocompetence may be different in patients with previous malignant disease, we investigated the corresponding risk in patients with earlier or existing malignant disease at the time of surgery. METHODS: In a prospective cohort of 766 BIS-monitored patients anesthetized with sevoflurane, new malignant diagnoses and death within 5 years after surgery were retrieved. Cox regression was used to assess the risk of new cancer and all-cause death during follow-up in relation to (T-ANESTH) and (T-BIS less than45). RESULT: Fifty-one patients (6.7%) were assigned 54 new malignant diagnoses within 5 years after surgery. Cancer surgery comprised 387 (51%) of the index operations. Two hundred ninety-three (38 %) of the patients died during follow-up. No relation between T-ANESTH or T-BIS less than45 and new malignant disease (hazard ratio [HR] 0.64-1.11 and 0.76-1.30, respectively) or death was found (HR 0.85-1.05 and 0.94-1.16, respectively). Nor were any corresponding significant relations obtained when other thresholds for BIS (i.e., less than 30, 40, and 50, respectively) were investigated. CONCLUSION: In patients with previous or existing malignant disease, neither duration of anesthesia nor increased cumulative time with profound sevoflurane anesthesia was associated with an increased risk for new cancer or death within 5 years after surgery. Monitoring depth of anesthesia is not expected to alter the risk of cancer proliferation after surgery.
|
|
| 4. |
- Lindholm, Maj-Lis, et al.
(author)
-
Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease
- 2009
-
In: ANESTHESIA AND ANALGESIA. - : Ovid Technologies (Wolters Kluwer Health). - 0003-2999 .- 1526-7598. ; 108:2, s. 508-512
-
Journal article (peer-reviewed)abstract
- BACKGROUND: A correlation between deep anesthesia (defined as time with Bispectral Index (BIS) <45; T-BIS <45 and death within 1. yr after surgery has previously been reported. In order to confirm or refute these findings, we evaluated T-BIS (<45) as an independent risk factor for death within I and 2 yr after surgery and also the impact of malignancy, the predominant cause of death in the previous report. METHODS: Mortality within 2 yr after surgery, causes of death and the occurrence of malignant disease at the time of surgery were identified in a cohort of 4087 BIS-monitored patients. Statistically significant univariate predictors of mortality were identified. In order to allow for comparison with previous data, the following multivariate analysis was first done without, and thereafter with, preexisting malignancy status, the predominant cause of death. RESULTS: One-hundred-seventy-four (4.3%) patients died within I yr and another 92 during the second year (totaling 6.5% in 2 yr). T-BIS <45 was a significant predictor of 1- and 2-yr mortality when preexisting malignant disease was not among the co-variates (hazard ratio [HR] 113 [1.01-1.27] and 1.18 [1.08-1.29], respectively). Further exploration confined the significant relation between postoperative mortality and T-BIS <45 to Patients with preexisting malignant diagnoses associated with extensive Surgery and less favorable prognosis. The most powerful predictors of 2-yr mortality in the model, including preexisting malignancy, were ASA physical score class IV (HR 19.3 [7.31-51.1]), age >80 yr (HR 2.93 [1.79-4.79]), and preexisting malignancy associated with less favorable prognosis (HR 9.30 [6.60-13.1]). When the initial multivariate regression was repeated using preexisting malignancy status among the co-variates in the model, the previously significant relation between 1, and 2-yr mortality and T-BIS <45 did not reach statistical significance. CONCLUSION: Using a similar set of co-variates as in previous work, we confirmed the statistical relation between 1-yr mortality and T-BIS <45, and we extended this observation to 2-yr mortality. However, this relation is sensitive to the selection of co-variates in the statistical model, and a randomized study is required to demonstrate that there really is a causal impact from and T-BIS (<45) on postoperative mortality and, if it does, the effect is probably very weak in comparison with co-morbidity as assessed by ASA physical score, the preexisting malignancy status at surgery and age.
|
|
| 5. |
- Lindholm, Maj-Lis
(author)
-
Utility of bispectral index (BIS) monitoring during general anesthesia
- 2009
-
Doctoral thesis (other academic/artistic)abstract
- The possibility to objectively measure effects from anesthetics on the level of consciousness has since long been desired. General anesthetics cause changes in brain electrical activity, seen as changes in the electroencephalogram (EEG). Devices utilizing processed EEG for pseudo-quantification of anesthetic depth have been available for more than ten years. These monitors display the anesthetic, or rather, hypnotic depth as an index number. In this thesis, some aspects of the use and utility of one such device, the Bispectral index scale (BIS) has been evaluated. The effects from experience and education on the use and utility of BIS monitoring were analyzed within a group of nurse anesthetists. Available BIS monitoring was found to have minimal effect on anesthetic gas delivery and BIS levels, and this did not change with growing experience and repeated education. However, the user approval, expressed as subjectively rated utility of the monitoring, increased markedly with mounting experience. The BIS has been thoroughly investigated concerning potential short term benefits, achieved by titrating of anesthesia by the use of the monitor. Marginal reduction in wake up time, shortening of time spent in the postoperative ward, and a reduced incidence of postoperative nausea and vomiting have been shown, but only when BIS values were close to the upper limit of the recommended range. Regarding long term effects from deep anesthesia, time spent at deep hypnotic level as displayed by BIS < 45, has been associated with increased postoperative mortality. It has been speculated that deep anesthesia could cause or worsen malignant disease, possibly by negatively affecting the immune system. In this thesis, no such relation was found between postoperative mortality within two years after surgery and time spent with BIS< 45. Neither was any relation found between the development of new malignant disease within five years after surgery and time spent at deep hypnotic level. Underdosing of anesthetics may result in unintended wakefulness, awareness, which besides being a very unpleasant experience, can have long term psychological consequences for the individual. We compared the incidence of awareness in a BIS monitored cohort of patients to that in a historical control group with no such monitoring. Compared to standard praxis, we found a reduction in the incidence of awareness by 77% when BIS monitoring was used. In summary, the possibility to avoid unnecessarily deep anesthesia by the use of BIS was not adhered to despite mounting experience and educational efforts. Increasing experience was, however, associated with increased subjectively rated utility of the BIS technology. Since anesthesia exposure in terms of time with low BIS was not found to affect long term mortality or the occurrence of malignant disease, the main benefit of BIS monitoring thus far seems to be the possibility to reduce the risk of underdosing of anesthetics, that is, awareness.
|
|
| 6. |
- Suleman Khan, Muhammad, et al.
(author)
-
Pharmacogenetics, Plasma Concentrations, Clinical Signs and EEG During Propofol Treatment
- 2014
-
In: Basic & Clinical Pharmacology & Toxicology. - : Wiley. - 1742-7835 .- 1742-7843. ; 115:6, s. 565-570
-
Journal article (peer-reviewed)abstract
- A variety of techniques have been developed to monitor the depth of anaesthesia. Propofols pharmacokinetics and response vary greatly, which might be explained by genetic polymorphisms. We investigated the impact of genetic variations on dosage, anaesthetic depth and recovery after total intravenous anaesthesia with propofol. A total of 101 patients were enrolled in the study. The plasma concentration of propofol during anaesthesia was measured using high-performance liquid chromatography. EEG was monitored during the surgical procedure as a measure of anaesthetic depth. Pyrosequencing was used to determine genetic polymorphisms in CYP2B6, CYP2C9, the UGTIA9-promotor and the GABRE gene. The correlation between genotype and to plasma concentration at the time of loss of consciousness (LOC), the total induction dose, the time to anaesthesia, eye opening and clearance were investigated. EEG monitoring showed that the majority of the patients had not reached a sufficient level of anaesthetic depth (subdelta) at the time of loss of consciousness despite a high induction dose of propofol. Patients with UGT1A9-331C/T had a higher propofol clearance than those without (p=0.03) and required a higher induction dose (p=0.03). The patients with UGT1A9-1818T/C required a longer time to LOC (p=0.03). The patients with CYP2C9*2 had a higher concentration of propofol at the time of LOC (p=0.02). The polymorphisms in the metabolizing enzymes and the receptor could not explain the large variation seen in the pharmacokinetics of propofol and the clinical response seen. At LOC, the patients showed a large difference in EEG pattern.
|
|
| 7. |
- von Brömssen, Kerstin, 1952-, et al.
(author)
-
Språkutvecklande ”tvillingläsning" av skönlitteratur för migranter inom vuxenutbildningen
- 2023
-
In: Abstracts för Decemberkonferensen. - Trollhättan : Högskolan Väst.
-
Conference paper (other academic/artistic)abstract
- Föreliggande pilotprojekt belyser och problematiserar vuxenstuderande migranters (på SFI) erfarenheter av parallell läsning av skönlitteratur på sitt förstaspråk och på svenska. Undervisningen i tvillingläsning går ut på att kursdeltagarna parallellt läser skönlitteratur på svenska och på ett annat språk, det vill säga har samma text framför sig på två språk. Genom tvillingläsning jämförs språken kontinuerligt, vilket skapar förutsättningar för ökad språk- och litteracitetsutveckling.Pilotprojektet är ett praktiknära forskningsprojekt som använder sig av teorier om litteracitet och flerspråkighet. Studien är kvalitativ med intervjuer och textanalys av läsjournaler som empiri. Syftet är att undersöka om tvillingläsning av skönlitteratur på modersmålet/det starkaste språket och svenska kan bidra till språklig utveckling i svenska som andraspråk. Studien fokuserar följande frågeställningar:· Hur erfar kursdeltagare inom SFI "tvillingläsning" av skönlitteratur på både modersmål och svenska och hur berättar kursdeltagarna om sina erfarenheter av tvillingläsning?· Vilka teman och vilket innehåll i den lästa skönlitteraturen blir viktiga för kursdeltagarna i SFI?· Hur uppfattar lärare på SFI att tvillingläsning av skönlitteratur påverkar kursdeltagarnas språkutveckling i svenska språket?Ett preliminärt resultat är att tvillingläsningen bidragit till ett mer nyanserat språk, ökat läsengagemang samt ett intresse för språkliga jämförelser, översättnings- och kulturfrågor. Migranterna/kursdeltagarna har upptäckt läsningen som en ingång till språket. De uttrycker att de kan läsa mer avancerad litteratur och inte är bundna till lättläst litteratur, men vi kunde också se en variation beroende på migranternas litteracitetsnivå. Migranter som tidigare inte varit intresserade av läsning uttrycker att de via projektet fått upp ett intresse för skönlitteratur. I intervjuerna med lärarna nämns ökat läsflyt, talflyt, breddat ordförråd, förståelse för grammatiska strukturer och läsförståelse.
|
|
| 8. |
- Zetterlund, Eva-Lena, et al.
(author)
-
Determination of loss of consciousness: a comparison of clinical assessment, bispectral index and electroencephalogram: An observational study
- 2016
-
In: European Journal of Anaesthesiology. - : Lippincott Williams & Wilkins. - 0265-0215 .- 1365-2346. ; 33:12, s. 922-928
-
Journal article (peer-reviewed)abstract
- BACKGROUNDComputer-processed algorithms of encephalographic signals are widely used to assess the depth of anaesthesia. However, data indicate that the bispectral index (BIS), a processed electroencephalography monitoring system, may not be reliable for assessing the depth of anaesthesia.OBJECTIVEThe aim of this study was to evaluate the ability of the BIS monitoring system to assess changes in the level of unconsciousness, specifically during the transition from consciousness to unconsciousness, in patients undergoing total intravenous anaesthesia with propofol. We compared BIS with the electroencephalogram (EEG), and clinical loss of consciousness (LOC) defined as loss of verbal commands and eyelash reflex.DESIGNThis was an observational cohort study.SETTINGUniversity Hospital Linkoping, University Hospital orebro, Finspang Hospital and Kalmar Hospital, Sweden from October 2011 to April 2013.PATIENTSA total of 35 ASA I patients aged 18 to 49 years were recruited.INTERVENTIONSThe patients underwent total intravenous anaesthesia with propofol and remifentanil for elective day-case surgery. Changes in clinical levels of consciousness were assessed by BIS and compared with assessment of stage 3 neurophysiological activity using the EEG. The plasma concentrations of propofol were measured at clinical LOC and 20 and 30min after LOC.MAIN OUTCOME MEASURESThe primary outcome was measurement of BIS, EEG and clinical LOC.RESULTSThe median BIS value at clinical LOC was 38 (IQR 30 to 43), and the BIS values varied greatly between patients. There was no correlation between BIS values and EEG stages at clinical LOC (r=-0.1, P=0.064). Propofol concentration reached a steady state within 20min.CONCLUSIONThere was no statistically significant correlation between BIS and EEG at clinical LOC. BIS monitoring may not be a reliable method for determining LOC.CLINICAL TRIALS REGISTRYThis trial was not registered because registration was not mandatory at the time of the trial.
|
|
