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Södertälje, Sweden

Ekdahl A.W.,Vrinnevi Hospital | Ekdahl A.W.,Linkoping University | Andersson L.,Linkoping University | Friedrichsen M.,Linkoping University | Friedrichsen M.,Palliative Education and Research Center
Patient Education and Counseling | Year: 2010

Objective: To deepen the knowledge of frail elderly patients' preferences for participation in medical decision making during hospitalization. Methods: Qualitative study using content analysis of semi-structured interviews. Results: Patient participation to frail elderly means information, not the wish to take part in decisions about their medical treatments. They view the hospital care system as an institution of power with which they cannot argue. Participation is complicated by barriers such as the numerous persons involved in their care who do not know them and their preferences, differing treatment strategies among doctors, fast patient turnover in hospitals, stressed personnel and linguistic problems due to doctors not always speaking the patient's own language. Conclusion: The results of the study show that, to frail elderly patients, participation in medical decision making is primarily a question of good communication and information, not participation in decisions about medical treatments. Practice implications: More time should be given to thorough information and as few people as possible should be involved in the care of frail elderly. Linguistic problems should be identified to make it possible to take the necessary precautions to prevent negative impact on patient participation. © 2009 Elsevier Ireland Ltd. Source

Milovanovic M.,Vrinnevi Hospital
Pathophysiology of haemostasis and thrombosis | Year: 2010

Essential thrombocythemia (ET) is characterized by high platelet counts and a slightly increased bleeding risk. Why severe hemorrhage does not occur more frequently is not known. Variations of platelet density (kg/l) depend mainly on cell organelle content in that high-density platelets contain more α and dense granules. This study compares ET patients (n = 2) and healthy volunteers (n = 2) with respect to platelet density subpopulations. A linear Percoll™ gradient containing prostaglandin E(1) was employed to separate platelets according to density. The platelet population was subsequently divided by density into 16 or 17 subpopulations. Determination of platelet counts was carried out. In each density fraction, platelet in vivo activity, i.e. platelet-bound fibrinogen, was measured using a flow cytometer. To further characterize platelet subpopulations, we determined intracellular concentrations of CD40 ligand (CD40L) and P-selectin in all fractions. Patients and controls demonstrated similar density distributions, i.e. 1 density peak. High-density platelets had more surface-bound fibrinogen in conjunction with signs of platelet release reactions, i.e. with few exceptions they contained less CD40L and P-selectin. Peak density platelets showed less surface-bound fibrinogen. These platelets contained less CD40L and P-selectin than nearby denser populations. The light platelets had more surface-bound fibrinogen than peak platelets together with elevated concentrations of CD40L. In ET, the malignant platelet production could exist together with platelets originating from normal megakaryocytes. It is also possible that clonal megakaryocytes produce platelets covering the entire density span. The 'normal' density distribution offers a tenable explanation as to why serious bleedings do not occur more frequently. Copyright © 2010 S. Karger AG, Basel. Source

Kallstrom R.,Linkoping University | Hjertberg H.,Vrinnevi Hospital | Svanvik J.,Linkoping University
Journal of Endourology | Year: 2010

Purpose: To examine the content and construct validity of a full procedure transurethral prostate resection simulation model (PelvicVision). Materials and Methods: The full procedure simulator consisted of a modified resectoscope connected to a robotic arm with haptic feedback, foot pedals, and a standard desktop computer. The simulation calculated the flow of irrigation fluid, the amount of bleeding, the corresponding blood fog, the resectoscope movements, resection volumes, use of current, and blood loss. Eleven medical students and nine clinically experienced urologists filled in questionnaires regarding previous experiences, performance evaluation, and their opinion of the usefulness of the simulator after performing six (students) and three (urologists) full procedures with different levels of difficulty. Their performance was evaluated using a checklist. Results: The urologists finished the procedures in half the time as the students with the same resection volume and blood loss but with fewer serious perforations of the prostatic capsule and/or sphincter area and less irrigation fluid uptake. The resectoscope tip movement was longer and the irrigation fluid uptake per resected volume was about 5 times higher for the students. The students showed a positive learning curve in most variables. Conclusion: There is proof of construct validity and good content validation for this full procedure simulator for training in transurethral resection of the prostate. The simulator could be used in the early training of urology residents without risk of negative outcome. © Mary Ann Liebert, Inc. 2010. Source

Chabok A.,Uppsala University | Pahlman L.,Uppsala University | Hjern F.,Karolinska Institutet | Haapaniemi S.,Vrinnevi Hospital | Smedh K.,Uppsala University
British Journal of Surgery | Year: 2012

Background: The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. The aim was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis, with the endpoint of recovery without complications after 12 months of follow-up. Methods: This multicentre randomized trial involving ten surgical departments in Sweden and one in Iceland recruited 623 patients with computed tomography-verified acute uncomplicated left-sided diverticulitis. Patients were randomized to treatment with (314 patients) or without (309 patients) antibiotics. Results: Age, sex, body mass index, co-morbidities, body temperature, white blood cell count and C-reactive protein level on admission were similar in the two groups. Complications such as perforation or abscess formation were found in six patients (1·9 per cent) who received no antibiotics and in three (1·0 per cent) who were treated with antibiotics (P = 0·302). The median hospital stay was 3 days in both groups. Recurrent diverticulitis necessitating readmission to hospital at the 1-year follow-up was similar in the two groups (16 per cent, P = 0·881). Conclusion: Antibiotic treatment for acute uncomplicated diverticulitis neither accelerates recovery nor prevents complications or recurrence. It should be reserved for the treatment of complicated diverticulitis. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

Background In the coming half-century, the population of old people will increase, especially in the oldest age groups. Therefore, the prevalence of multiple chronic conditions, and consequently, the need of health care including care in hospital, is rising. Materials and methods This article includes results from three mainly qualitative articles (interviews with frail old people, physicians, and an observational study in acute medical wards) and a cross-sectional survey of newly discharged elderly patients. Results Health care does not take a holistic approach to patients with more complex diseases, such as frail old people. The remuneration system rewards high production of care in terms of numbers of investigations and operations, turnover of hospital beds, and easy accessibility to care. Frail old people do not feel welcome in hospital, with their complex diseases and a need of more time to recover. The staff providing care feels frustrated, and often guilty when taking care of old people. Discussion and conclusion To improve quality of care of frail elderly, a model is suggested with the following main components: more hospital wards which can address the patients' whole situation medically, functionally, and psychologically, i.e comprehensive geriatric assessment (CGA). Better identification of frail elderly people is necessary, together with a change in remuneration system, with a focus on the patients' functional status and quality of life. More training in geriatrics is required for staff to feel confident when treating frail old people. © 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. Source

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