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Kristianstad, Sweden

Wernerman J.,Karolinska University Hospital | Kirketeig T.,Karolinska University Hospital | Andersson B.,Sahlgrenska University Hospital | Berthelson H.,Kristianstad Hospital | And 8 more authors.
Acta Anaesthesiologica Scandinavica

Background: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. Methods: Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. Results: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. Conclusion: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients. © 2011 The Authors. Acta Anaesthesiologica Scandinavica. Source

Strand K.,Akershus University Hospital | Strand K.,University of Stavanger | Walther S.M.,Linkoping University | Reinikainen M.,North Karelia Central Hospital | And 7 more authors.
Critical Care

Introduction: The length of stay (LOS) in intensive care unit (ICU) nonsurvivors is not often reported, but represents an important indicator of the use of resources. LOS in ICU nonsurvivors may also be a marker of cultural and organizational differences between units. In this study based on the national intensive care registries in Finland, Sweden, and Norway, we aimed to report intensive care mortality and to document resource use as measured by LOS in ICU nonsurvivors.Methods: Registry data from 53,305 ICU patients in 2006 were merged into a single database. ICU nonsurvivors were analyzed with regard to LOS within subgroups by univariate and multivariate analysis (Cox proportional hazards regression).Results: Vital status at ICU discharge was available for 52,255 patients. Overall ICU mortality was 9.1%. Median LOS of the nonsurvivors was 1.3 days in Finland and Sweden, and 1.9 days in Norway. The shortest LOS of the nonsurvivors was found in patients older than 80 years, emergency medical admissions, and the patients with the highest severity of illness. Multivariate analysis confirmed the longer LOS in Norway when corrected for age group, admission category, sex, and type of hospital. LOS in nonsurvivors was found to be inversely related to the severity of illness, as measured by APACHE II and SAPS II.Conclusions: Despite cultural, religious, and educational similarities, significant variations occur in the LOS of ICU nonsurvivors among Finland, Norway, and Sweden. Overall, ICU mortality is low in the Scandinavian countries. © 2010 Strand et al.; licensee BioMed Central Ltd. Source

Brogren E.,Lund University | Brogren E.,Skane University Hospital | Hofer M.,Kristianstad Hospital | Petranek M.,Hassleholm Hospital | And 4 more authors.
BMC Musculoskeletal Disorders

Background: Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods. The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score 15 and the number needed to harm (NNH) were calculated. Results: The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength. Conclusion: Malunion after distal radius fracture was associated with higher arm-related disability regardless of age. © 2011 Brogren et al; licensee BioMed Central Ltd. Source

Ghatnekar O.,The Swedish Institute for Health Economics | Ljungberg A.,Abbott Laboratories | Wirestrand L.-E.,Kristianstad Hospital | Svensson A.,Lund University
European Journal of Dermatology

Objectives: Knowledge of the societal costs of psoriasis is limited. This study estimated the cost of care, psoriasis area and severity index (PASI), and quality of life in a defined patient population in Sweden. Methods: A prevalence-based prospective recruitment of patients visiting two Swedish dermatology clinics between September and December 2009was performed, collecting resource utilization for health care contacts, treatment, travelling, and productivity loss during 1 month. Results: 164 patients were included. Mean total cost per patient-month was 994€. Main cost drivers were outpatient visits and light therapy (49%), biological drugs (20%) and productivity loss (22%). Total cost for topical treatment only (TT; 34%) was 369€, light therapy (LT; 24%) 1,274€, traditional systemic treatment (TST; 26%) 1,085€ and biological systemic treatment (BST; 16%) 1,709€ per patient-month. Main cost drivers were: outpatient visits (56%) in TT as well as for LT (78%), productivity loss (40%) in TST, and biological drugs (71%) among BST patients. There was no clear relationship between clinical (PASI) or subjective (DLQI) severity estimations and costs. Conclusions: The one-month cost-of-illness amounted to almost 1,000€/month, with great variations. Despite 1,190€ difference in drug cost for TST vs BST, total cost per month differed by 623€ because of offsets from improved productivity. A trend towards lower severity and reductions in outpatient and topical treatment costs was seen. Source

Andersson C.,Skane University Hospital | Carlsson A.,Skane University Hospital | Cilio C.,Skane University Hospital | Cedervall E.,Helsingborg Hospital | And 7 more authors.
Pediatric Diabetes

Aims: Children with type 1 diabetes (T1D) risk and islet autoantibodies are recruited to a secondary prevention study. The aims were to determine metabolic control in relation to human leukocyte antigen (HLA) genetic risk and islet autoantibodies in prepubertal children. Methods: In 47 healthy children with GADA and at least one additional islet autoantibody, intravenous glucose tolerance test (IvGTT) and oral glucose tolerance test (OGTT) were performed 8-65d apart. Hemoglobin A1c, plasma glucose as well as serum insulin and C-peptide were determined at fasting and during IvGTT and OGTT. Results: All children aged median 5.1 (4.0-9.2) yr had autoantibodies to two to six of the beta-cell antigens GAD65, insulin, IA-2, and the three amino acid position 325 variants of the ZnT8 transporter. In total, 20/47 children showed impaired glucose metabolism. Decreased (≤30 μU/mL insulin) first-phase insulin response (FPIR) was found in 14/20 children while 11/20 had impaired glucose tolerance in the OGTT. Five children had both impaired glucose tolerance and FPIR ≤30 μU/mL insulin. Number and levels of autoantibodies were not associated with glucose metabolism, except for an increased frequency (p=0.03) and level (p=0.01) of ZnT8QA in children with impaired glucose metabolism. Among the children with impaired glucose metabolism, 13/20 had HLA-DQ2/8, compared to 9/27 of the children with normal glucose metabolism (p=0.03). Conclusion: Secondary prevention studies in children with islet autoantibodies are complicated by variability in baseline glucose metabolism. Evaluation of metabolic control with both IvGTT and OGTT is critical and should be taken into account before randomization. All currently available autoantibody tests should be analyzed, including ZnT8QA. © 2013 John Wiley & Sons A/S. Source

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