Somoskovi A.,Skaraborg Hospital
Journal of Clinical Microbiology | Year: 2015
To realize the most benefit from multidrug-resistant tuberculosis (MDR-TB) screening, all nucleic acid amplification test (NAAT)-positive respiratory specimens should be universally tested. Once an MDR-TB diagnosis is established, additional testing is warranted to provide details about the detected mutations. © 2015, American Society for Microbiology.
Jeppsson A.,Sahlgrenska University Hospital |
Jeppsson A.,Gothenburg University |
Walden K.,Eastern Hospital |
Roman-Emanuel C.,Sahlgrenska University Hospital |
And 2 more authors.
British Journal of Anaesthesia | Year: 2016
Background: Bleeding remains a severe complication in cardiac surgery. Several studies have found an association between the preoperative plasma concentration of fibrinogen and postoperative bleeding in cardiac surgery patients. This raises the question of whether preoperative supplementation with fibrinogen concentrate can reduce postoperative blood loss. Methods: An investigator-initiated, prospective, randomized double-blind placebo-controlled study, was performed in 48 low-risk, coronary artery bypass grafting patients. Subjects were randomized to infusion of 2 g fibrinogen or placebo immediately before surgery, after induction of anaesthesia. The primary endpoint was blood loss during the first 12 h postoperatively. Secondary endpoints included the proportion of transfused subjects, the number of transfused allogeneic blood products (red blood cells, plasma and platelets), and haemoglobin concentration after surgery. Student's t-test and Mann-Whitney U-test was used to compare continuous data and χ2-test to compare categorical data between groups. Results: Median postoperative bleeding was not significantly different between the fibrinogen and placebo groups [650 (25/75th percentile 500-835) ml compared with 730 (543-980) ml, P=0.29]. The proportion of transfused subjects (33 vs 29%, P=0.76), number of perioperative transfusions of allogeneic blood products (0 (0-2 vs 0 (0-3), P=0.76) and haemoglobin concentration 24 h after surgery (107 (sd 11) vs 100 (12) g L-1, P=0.07) were not significantly different between the fibrinogen and placebo group, respectively. Conclusions: Preoperative supplementation with 2 g fibrinogen concentrate did not significantly influence postoperative bleeding, in coronary artery bypass grafting patients without documented hypofibrinogenaemia. © 2015 The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Johansson I.,Gothenburg University |
Martensson G.,Gothenburg University |
Nystrom U.,Sahlgrenska University Hospital |
Nasic S.,Skaraborg Hospital |
Andersson R.,Gothenburg University
BMC Infectious Diseases | Year: 2013
Background: Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue. Methods: We performed a retrospective, single-centre study of 114 lung transplant recipients (LTRs) who underwent lung transplantation from January 2001 to December 2006. In a smaller cohort of 88 CMV seropositive (R+) LTRs, three months of valganciclovir prophylaxis (2004-2006) was compared to three months of oral ganciclovir (2001-2003) with respect to the incidence of CMV infection/disease, the severity of CMV disease, acute rejection, BOS-free 4 year survival and 4 year survival. In the whole group of 114 LTRs the impact of CMV infection on long-term survival (BOS free 4 year survival and 6 year survival) was assessed. Results: For the cohort of 88 CMV seropositive LTRs, the incidence of CMV infection/disease at one year was lower in the valganciclovir group compared to the ganciclovir group (24% vs. 54%, p = 0.003). There was a tendency towards reduced CMV disease, from 33% to 20% and a significant lower incidence of asymptomatic CMV infection (22% vs. 4%, p = 0.005). A lower incidence of acute rejection was observed in the valganciclovir group. However, there was no significant difference between the two groups in BOS free 4 year survival and 4 year survival.For the entire group of 114 LTRs, BOS-free 4 year survival for recipients with CMV disease was (32%, p = 0.005) and among those with asymptomatic CMV infection (36%, p = 0.061) as compared with patients without CMV infection (69%). Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) than patients without CMV infection (84%). Conclusions: A lower incidence of CMV infection/disease and acute rejections was observed with valganciclovir (3 months) when compared to oral ganciclovir (3 months). The long-term impact of CMV infection/disease was significant for BOS-free survival and survival. © 2013 Johansson et al.; licensee BioMed Central Ltd.
Celen Y.T.,Skaraborg Hospital |
Hedner J.,Sahlgrenska University Hospital |
Carlson J.,Sahlgrenska University Hospital |
Peker Y.,Skaraborg Hospital |
Peker Y.,Sahlgrenska University Hospital
Journal of Clinical Sleep Medicine | Year: 2010
Study Objective: To address the influence of gender and obstructive sleep apnea (OSA) on development of diabetes mellitus (DM) in a sleep clinic cohort. Design: A longitudinal observational study. Participants: A consecutive middle-aged (30-69 years) sleep clinic cohort from 1991 (n = 318; 254 men, 64 women) with eligible baseline characteristics, clinical charts, and information from the Swedish Hospital Discharge Registry were identified. Ten individuals with DM at baseline and 47 patients who died during the follow-up period were excluded. Measurements: The remaining 261 subjects were asked to complete a postal questionnaire regarding concomitant diseases including DM, diagnosed by a physician. Results: In total, 168 patients (64.4%) replied. The incidence of DM was 24.9% in patients with OSA (overnight oxygen desaturations ≥ 30 in 1991) compared with 10.8% in subjects without OSA (p = 0.020). New-onset DM in men was 19.1% in OSA vs 11.1% in non-OSA (n.s.), while the corresponding values in women were 50.0% in OSA and 9.5% in non-OSA (p = 0.022). In a multivariate analysis, DM was predicted by OSA in women with an odds ratio (OR) of 11.8, but not by age, body mass index (BMI) at baseline, or weight change at follow-up. In men, only BMI (OR 1.16) predicted DM. Conclusion: The contribution of OSA to DM development seems to be gender-dependent and higher in women than in men.
Ayala M.,Skaraborg Hospital
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2014
Purpose: The aim of this work was to study the reduction in intraocular pressure (IOP) after two selective laser trabeculoplasty (SLT) treatments in the same area of the trabecular meshwork (TM) compared to two SLT treatments in two different areas of the TM when the initial SLT treatment has failed. Methods: This was a prospective randomized clinical trial for testing the effect of repeated SLT treatments in reducing IOP. The patients in the study all suffered from primary open-angle or pseudoexfoliation glaucoma. All patients were treated initially with SLT (SLT 1) over 180 in the lower half of the TM. Patients who were chosen for retreatment with SLT (SLT 2) were asked to participate in the study. The patients in the study were randomized to either SLT 2 in the same, already-treated TM area or to SLT 2 in the upper untreated TM area. The IOP was measured before and 2 h, 1 month, 3 months, and 6 months after the SLT 2 treatment. Patients who changed medical therapy regimens during this time were excluded. Results: A total of 40 patients were included in both groups. At baseline, there were no significant differences between the groups in regards to age (t-test, p = 0.44), gender (χ2, p = 0.14), pseudoexfoliation glaucoma (χ2, p = 0.07), time between SLT 1 and SLT 2 (t-test, p = 0.78), IOP before SLT 1 (t-test, p = 0.78), or IOP before SLT 2 (t-test, p = 0.32). At the conclusion of the study, there were no significant differences in IOP between the groups 2 h (t-test, p = 0.65), 1 month (t-test, p = 0.60), 3 months (t-test, p = 0.42), or 6 months (t-test, p = 0.66) after the SLT 2 treatment. Conclusions: Two SLT treatments of the same TM area do not have a significant effect on IOP compared to two SLT treatments in two different areas. © 2013 Springer-Verlag Berlin Heidelberg.
Lantz B.,University of Borås |
Ottosson C.,Skaraborg Hospital
Scandinavian Journal of Caring Sciences | Year: 2013
Background: It is well established that parents must interact with their new-born babies to facilitate attachment. However, very little is known about how parents perceive different types of medical technology products commonly used in the neonatal intensive care unit (NICU) as barriers to their wish to interact with their infants. Aim: This study aims to examine to what extent the different medical technology products commonly used in the NICU are perceived by parents to be obstacles in their wish to interact with their babies. Design and methods: In 2010, a cross-sectional survey, using a questionnaire specifically developed for this study, was conducted among the parents of children who were discharged from any of the five NICUs of the Västra Götaland region in Sweden. A consecutive sample of 248 parents participated, and multiple regressions and t-tests were used to analyse the data. Results: The parents generally perceived the various medical technology products differently, according to the perceived level of obstruction. The variables of gender, age, educational level, origin, gestational age, previous experience of being a parent, and the offer of accommodation at the NICU were significantly associated with the perceived level of obstruction in the parents' wish to interact with their baby while the baby was being treated with different medical technology products. Conclusion: The primary implication for practice is that to facilitate attachment, nurses should involve different categories of parents in different ways in the care of their children, depending on the equipment being used in the treatment of the children. Thus, the individual care plan should explicitly include the details of the specific medical equipment, because although its use is medically beneficial for the child, it is associated with potential liabilities regarding parent-child interaction and, consequently, regarding parent-child attachment. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.
Jacobsson G.,Skaraborg Hospital |
Nasic S.,Skaraborg Hospital
Scandinavian Journal of Infectious Diseases | Year: 2012
Background: Short-term mortality from invasive Staphylococcus aureus infections (ISA) is high. Death rates from 20% to 60% are reported. Long-term outcome has not been investigated. Studies of other critical illnesses have demonstrated incremental health effects that persist after hospital discharge. Several researchers have proposed that evaluation of mortality secondary to sepsis should take place after 1 y. Methods: We performed an observational, prospective, population-based study of long-term mortality and recurrence in a cohort of ISA patients during 2 y. Results: One hundred and fifty-seven patients were included. All-cause mortality after 1 y was 37.6% and after 3 y was 45.5%. The multivariate survival analysis explored different independent factors for short-term compared to long-term mortality. Age, comorbidity, and place of acquisition were the determinants of long-term outcome. In contrast, infection-related factors such as disease severity and systolic blood pressure determined short-term mortality. The relapsereinfection rate was 11.2% (16 in 143 episodes in 127 patients living 4 weeks after inclusion). Predictive factors for relapsereinfection in a univariate analysis were joint prosthesis (28.6%, p = 0.027), haemodialysis (27.8%, p = 0.017), kidney disease (22.2%, p = 0.015), and healthcare- and nosocomial-related infection (18.3%, p = 0.029). No association to length of antibiotic therapy and relapsereinfection rate was observed, nor any sex differences. The majority of relapsesreinfections (11 of 16) occurred during the first 11 months after the initial episode. Conclusion: Patients with ISA infections, irrespective of age, suffer a high long-term mortality and recurrence rate. © 2012 Informa Healthcare.
Landgren M.,Skaraborg Hospital |
Svensson L.,Skaraborg Hospital |
Stromland K.,Gothenburg University |
Gronlund M.A.,Gothenburg University
Pediatrics | Year: 2010
OBJECTIVES: The purposes of this investigation were to determine the frequencies of and associations between different neurodevelopmental disorders and to study the potential lasting effects of alcohol on children adopted from eastern Europe. METHODS: In a population-based, prospective, observational, multidisciplinary, cross-sectional, cohort study of 71 children adopted from eastern Europe, children were assessed 5 years after adoption, from pediatric, neuropsychological, and ophthalmologic perspectives. RESULTS: Fetal alcohol spectrum disorders, that is, fetal alcohol syndrome (FAS), partial FAS, and alcohol-related neurodevelopmental disorders, were identified for 52% of children; FAS was found for 30%, partial FAS for 14%, and alcohol-related neurodevelopmental disorders for 9%. Alcohol-related birth defects were found for 11% of children, all of whom also were diagnosed as having FAS. Mental retardation or significant cognitive impairment was found for 23% of children, autism for 9%, attention-deficit/hyperactivity disorder for 51%, and developmental coordination disorder for 34%. CONCLUSIONS: Fetal alcohol spectrum disorders and neurodevelopmental disorders were common in this long-term follow-up study of children adopted from orphanages in eastern Europe. Maternal alcohol consumption during pregnancy has long-lasting adverse effects, causing structural, behavioral, and cognitive damage despite a radically improved environment. Copyright © 2010 by the American Academy of Pediatrics.
Sundler A.J.,University of Skövde |
Sundler A.J.,Mälardalen University |
Pettersson A.,Skaraborg Hospital |
Berglund M.,University of Skövde
Nurse Education Today | Year: 2015
Simulation has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, the evidence in favour of this pedagogical approach is weak, and more knowledge is needed in support of its use. The aim of this study was (a) to explore the experiences of undergraduate nursing students when examining knowledge, skills and competences in clinical simulation laboratories with high-fidelity patient simulators and (b) to analyse these students' learning experiences during the examination. A phenomenological approach was used, and qualitative interviews were conducted among 23 second-year undergraduate nursing students-17 women and 6 men. The findings revealed that, irrespective of whether they passed or failed the examination, it was experienced as a valuable assessment of the students' knowledge and skills. Even if the students felt that the examination was challenging, they described it as a learning opportunity. In the examination, the students were able to integrate theory with practice, and earlier established knowledge was scrutinised when reflecting on the scenarios. The examination added aspects to the students' learning that prepared them for the real world of nursing in a safe environment without risking patient safety. The study findings suggest that examinations in clinical simulation laboratories can be a useful teaching strategy in nursing education. The use of high-fidelity patient simulators made the examination authentic. The reflections and feedback on the scenario were described as significant for the students' learning. Undergraduate nursing students can improve their knowledge, understanding, competence and skills when such examinations are performed in the manner used in this study. © 2015 Elsevier Ltd.
Forssgren A.,Skaraborg Hospital |
Nelzen O.,Skaraborg Hospital |
Nelzen O.,Uppsala University
European Journal of Vascular and Endovascular Surgery | Year: 2012
Objective: The study aims to compare the spectrum of leg ulcer aetiology in Skaraborg County in 1988 and 2002, an evaluation of 14 years of targeted leg ulcer intervention. Design: Cross-sectional study within the professional health-care system in Skaraborg County. Materials: In 2002, 621 leg ulcer patients were identified through a cross-sectional population survey. Methods: Half of the registered patients were randomly selected and offered clinical examination. A total of 198 patients with 246 legs underwent examination and were categorised in detail according to aetiology. Data were compared with the initial study in 1988. Results: Venous incompetence was present in 140 (57%) legs and the dominating cause in 94 (38%) of the leg ulcers, 40 (16%) due to deep venous incompetence. Arterial insufficiency was identified in 90 (37%) legs and the dominating aetiological factor in 41 legs (17%), eight (3%) being critical ischaemic ulcers. The relative risk (RR) of developing a leg ulcer in 2002 vs. 1988 was 0.77. The RR of a venous ulcer was reduced by 46%, arterial by 28%, while there was an increase in diabetic ulcers by 29% and multifactorial by 42%. Conclusion: The aetiological spectrum of leg ulcers has changed, most likely due to a new management strategy in the care of leg ulcer patients. © 2012 European Society for Vascular Surgery.