Landspítali University Hospital Research Archive
Not a member yet
7973 research outputs found
Sort by
Chlamydia trachomatis in Iceland: Prevalence, Clinico-epidemiological Features and Comparison of Cobas 480 CT/NG and Aptima Combo 2 (CT/NG) for Diagnosis.
No full textTo access publisher's full text version of this article click on the hyperlink belowThe aims of this study were to assess the prevalence of, and risk factors for, Chlamydia trachomatis in attendees recruited prospectively from October 2018 to January 2019 at the only sexually transmitted infections clinic in Iceland (in Reykjavík), and to evaluate the cobas 4800 CT/NG Test and Aptima Combo 2 Assay for C. trachomatis detection in male urine and female vaginal swabs. Prevalence of C. trachomatis was 15.8% among 487 women and 13.6% among 491 men (no Neisseria gonorrhoeae positive patients were found). C. trachomatis detection was independently and positively associated with being tested for contact tracing, 18-24 years of age, and reporting ≥ 6 sexual partners within 12 months. Reporting sex with non-residents of Iceland was associated with a lower risk of C. trachomatis infection. Both assays had a high sensitivity in detection of C. trachomatis (Aptima Combo 2: 100%; cobas 4800 CT/NG: 95.1%) and high specificity (100% and 99.6%, respectively). The high local prevalence of C. trachomatis and increased acquisition risk following sex with residents are of public health concern.
Keywords: Iceland; Neisseria gonorrhoeae; nucleic acid amplification; prevalence; risk factor; sexually transmitted disease; Chlamydia trachomatis.Landspitali University Hospital
Orebro County Council Research Committee
Foundation for Medical Research at Orebro University Hospita
Hepatotoxicity associated with ribociclib among breast cancer patients.
No full textTo access publisher's full text version of this article click on the hyperlink belo
Active conventional treatment and three different biological treatments in early rheumatoid arthritis: phase IV investigator initiated, randomised, observer blinded clinical trial.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadObjective: To evaluate and compare benefits and harms of three biological treatments with different modes of action versus active conventional treatment in patients with early rheumatoid arthritis.
Design: Investigator initiated, randomised, open label, blinded assessor, multiarm, phase IV study.
Setting: Twenty nine rheumatology departments in Sweden, Denmark, Norway, Finland, the Netherlands, and Iceland between 2012 and 2018.
Participants: Patients aged 18 years and older with treatment naive rheumatoid arthritis, symptom duration less than 24 months, moderate to severe disease activity, and rheumatoid factor or anti-citrullinated protein antibody positivity, or increased C reactive protein.
Interventions: Randomised 1:1:1:1, stratified by country, sex, and anti-citrullinated protein antibody status. All participants started methotrexate combined with (a) active conventional treatment (either prednisolone tapered to 5 mg/day, or sulfasalazine combined with hydroxychloroquine and intra-articular corticosteroids), (b) certolizumab pegol, (c) abatacept, or (d) tocilizumab.
Main outcome measures: The primary outcome was adjusted clinical disease activity index remission (CDAI≤2.8) at 24 weeks with active conventional treatment as the reference. Key secondary outcomes and analyses included CDAI remission at 12 weeks and over time, other remission criteria, a non-inferiority analysis, and harms.
Results: 812 patients underwent randomisation. The mean age was 54.3 years (standard deviation 14.7) and 68.8% were women. Baseline disease activity score of 28 joints was 5.0 (standard deviation 1.1). Adjusted 24 week CDAI remission rates were 42.7% (95% confidence interval 36.1% to 49.3%) for active conventional treatment, 46.5% (39.9% to 53.1%) for certolizumab pegol, 52.0% (45.5% to 58.6%) for abatacept, and 42.1% (35.3% to 48.8%) for tocilizumab. Corresponding absolute differences were 3.9% (95% confidence interval -5.5% to 13.2%) for certolizumab pegol, 9.4% (0.1% to 18.7%) for abatacept, and -0.6% (-10.1% to 8.9%) for tocilizumab. Key secondary outcomes showed no major differences among the four treatments. Differences in CDAI remission rates for active conventional treatment versus certolizumab pegol and tocilizumab, but not abatacept, remained within the prespecified non-inferiority margin of 15% (per protocol population). The total number of serious adverse events was 13 (percentage of patients who experienced at least one event 5.6%) for active conventional treatment, 20 (8.4%) for certolizumab pegol, 10 (4.9%) for abatacept, and 10 (4.9%) for tocilizumab. Eleven patients treated with abatacept stopped treatment early compared with 20-23 patients in the other arms.
Conclusions: All four treatments achieved high remission rates. Higher CDAI remission rate was observed for abatacept versus active conventional treatment, but not for certolizumab pegol or tocilizumab versus active conventional treatment. Other remission rates were similar across treatments. Non-inferiority analysis indicated that active conventional treatment was non-inferior to certolizumab pegol and tocilizumab, but not to abatacept. The results highlight the efficacy and safety of active conventional treatment based on methotrexate combined with corticosteroids, with nominally better results for abatacept, in treatment naive early rheumatoid arthritis.Academy of Finland
Finska Lakaresallskapet
South-Eastern Health Region, Norway, HUCH Institutional grant, Finland
Icelandic Society for Rheumatology
interregional grant from all health regions in Norway
NordForsk
Regionernes Medicinpulje, Denmark
Stockholm County Council
Swedish Medical Research Council (SMRC)
Swedish Rheumatism Association
Research Fund of University Hospital, Reykjavik, Icelan
Nurses job satisfaction and attitudes towards servant leadership during organizational reforms in health care services
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadTilgangur: Árið 2014 voru gerðar breytingar á heilbrigðisþjónustu
hér á landi sem leiddu til fækkunar á heilbrigðisumdæmum og samruna stofnana. Við breytingarnar varð til Heilbrigðisstofnun Norðurlands (HSN) með sex starfsstöðvar. Slíkar stjórnvaldsákvarðanir geta
haft áhrif á starfsánægju starfsmanna og því skiptir máli hvernig
stjórnendur bregðast við og innleiða þær. Tilgangurrannsóknarinnar
var að skoða starfsánægju hjúkrunarfræðinga á HSN skömmu eftir
skipulagsbreytingar, meta viðhorf þeirra til þjónandi forystu í fari
yfirmanna sinna í hjúkrun ásamt því að kanna hvort tengsl væru milli
þessara tveggja þátta.
Aðferð: Gögnum var safnað með könnun um starfsánægju og spurningalista um þjónandi forystu, Servant Leadership Survey (SLS) í íslenskri þýðingu. Spurningalistinn leiðir í ljós heildartölu þjónandi
forystu og átta undirþætti hennar. Þátttakendur voru hjúkrunarfræðingar á HSN (N=104) sem fengu spurningalistann í tölvupósti. Svarhlutfall var 47,1%. Við úrvinnslu gagna var notuð lýsandi tölfræði og
ályktunartölfræði.
Niðurstöður: Starfsánægja mældist há og fram komu sterk jákvæð
tengsl milli starfsánægju og þjónandi forystu. Heildarvægi þjónandi
forystu mældist 4,62 af 6,0 mögulegum (SD = 0,65). Meðalstigafjöldi
undirþátta lá á bilinu 3,39 til 5,01. Þrír af átta þáttum þjónandi forystu
(hugrekki, forgangsröðun í þágu annarra og falsleysi) voru undir
viðmiðunarmörkum (α < 0,7). Undirþáttur með hæsta gildið var
fyrirgefning en það gefurtil kynna að persónulegur ágreiningurtrufli
ekki samskipti hjúkrunarfræðinga og yfirmanna í hjúkrun á HSN.
Ályktanir: Niðurstöðurnar gefa til kynna að hjúkrunarfræðingar á
HSN, sem var nýlega stofnuð þegar rannsóknin fór fram, hafi verið
ánægðir í starfi og einkenni þjónandi forystu hafi verið til staðar hjá
yfirmönnum í hjúkrun á stofnuninni. Þá gefa þessar niðurstöður vísbendingar um að yfirmenn í hjúkrun á HSN hafi ráðið vel við þær
skipulagsbreytingar sem urðu á heilbrigðisþjónustunni á þjónustusvæði HSN.Aim: In 2014, changes were made to the organization of health
care services in Iceland, which led to a reduction in health disputes
and merging of institutions. During the changes, the Health Care
Institution of North Iceland (HSN) was established with six workstations. Such administrative decisions can affect the job satisfaction of employees and therefore it is of importance how managers
react to and implement such changes. The purpose of the study
was to examine the job satisfaction of nurses at HSN shortly after
the organizational changes and evaluate their attitudes towards
servant leadership of their nursing managers at HSN as well as explore the correlation between these two factors.
Method: Data was collected by a survey about job satisfaction and
the Icelandic translation of the Servant Leadership Survey (SLS). The
questionnaire measuresthe totalscores ofservant leadership and its
eight dimensions. Participants were nurses at HSN (N = 104) who
received the questionnaire via email. The response rate was 47.1%.
Descriptive and exploratory statistics was used to analyse the data.
Results: Job satisfaction was high and the results revealed a strong
positive correlation between job satisfaction and servant leadership. The overall value of servant leadership was 4.62 of 6.0 possible (SD = 0.65). The main score each dimension ranged from
3.39–5.01. Three of the eight dimensions of servant leadership
were statistically insignificant (courage, standing back and auhenticity (α < 0.7)). The dimension that scored highest was forgiveness, indicating that personal disagreement does not interfere with
communication between nurses and their nursing managers at
HSN.
Conclusions: The results indicate that nurses at newly established
HSN when the study was conducted, were satisfied with their job
and the characteristics of servant leadership were present among
the HSN’s nursing managers. The results also indicate the HSN’s
managers have handled well the organizational changes that have
taken place in the health service in the HSN area.
Keywords: Servant leadership, job satisfaction, organization
changes, nurses, women
Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.
Methods: A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.
Results: We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale -0.4 (-0.8 to 0.0) and Δnumeric pain rating scale -3.0 (-3.86 to -2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.
Conclusions: This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.SSAI
Norwegian Air Ambulance Foundatio
Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Walnut allergy is common across the globe, but data on the involvement of individual walnut components are scarce.
Objectives: To identify geographical differences in walnut component sensitization across Europe, explore cosensitization and cross-reactivity, and assess associations of clinical and serological determinants with severity of walnut allergy.
Methods: As part of the EuroPrevall outpatient surveys in 12 European cities, standardized clinical evaluation was conducted in 531 individuals reporting symptoms to walnut, with sensitization to all known walnut components assessed in 202 subjects. Multivariable Lasso regression was applied to investigate predictors for walnut allergy severity.
Results: Birch-pollen-related walnut sensitization (Jug r 5) dominated in Northern and Central Europe and lipid transfer protein sensitization (Jug r 3) in Southern Europe. Profilin sensitization (Jug r 7) was prominent throughout Europe. Sensitization to storage proteins (Jug r 1, 2, 4, and 6) was detected in up to 10% of subjects. The walnut components that showed strong correlations with pollen and other foods differed between centers. The combination of determinants best predicting walnut allergy severity were symptoms upon skin contact with walnut, atopic dermatitis (ever), family history of atopic disease, mugwort pollen allergy, sensitization to cat or dog, positive skin prick test result to walnut, and IgE to Jug r 1, 5, 7, or carbohydrate determinants (area under the curve = 0.81; 95% CI, 0.73-0.89).
Conclusions: Walnut-allergic subjects across Europe show clear geographical differences in walnut component sensitization and cosensitization patterns. A predictive model combining results from component-based serology testing with results from extract-based testing and information on clinical background allows for good discrimination between mild to moderate and severe walnut allergy.
Keywords: Allergen components; EuroPrevall; Europe; IgE sensitization; Prediction; Severity; Walnut allergy; iFAAM.European Commission
European Commission Joint Research Centr
Acute upper gastrointestinal bleeding: a population-based, five-year follow-up study.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: Data on long-term rebleeding risk and mortality in acute upper gastrointestinal bleeding (AUGIB) patients are scarce and comparison to controls are lacking. Aimsof the study were to assess long-term prognosis of AUGIB patients and compare to controls.
Methods: A population-based retrospective case-control study conducted at the National University Hospital of Iceland and included all patients who underwent endoscopy in 2010-2011. AUGIB was defined as haematemesis or coffee ground vomiting leading to hospitalization or occurring in a hospitalized patient. Controls underwent endoscopy in 2010-2011, matched for sex/age. Rebleeding was defined as AUGIB >14 days up to five years after index bleeding.
Results: Overall, 303 patients had AUGIB, mean age 67 (±18), controls66 years (±19), females, 51 and 46%, respectively. The five-year rebleeding rate for AUGIB patients was 13% (95%CI 9-17%), higher than the rate of bleeding events in controls, 3% (95%CI 1-5%; log-rank <0.001), hazard ratio (HR) 6.0 (95%CI 2.4-15) when correcting for comorbidities, NSAID's, PPI's and antithrombotics. The mortality of AUGIB patients at end of follow-up was higher when compared to controls, 39% (95%CI 49-33%) vs. 26% (95%CI 30-21%), log-rank <0.001, comorbidity-adjusted HR 1.4 (1.1-1.9). A subanalysis of non-variceal AUGIB yielded similar results in regard to rebleeding and mortality rates.
Conclusions: AUGIB patients were at 6-fold risk of rebleeding compared to bleeding events in controls at five years of follow-up. Five-year mortality was higher in AUGIB patients when compared to controls even when correcting for age and comorbidities, suggesting that an episode of AUGIB indicates serious frailty.
Keywords: GI-bleeding;; mortality;; outcome;; prognosis;; rebleeding; survival;
Arrest-related death on the basis of a drug-induced excited delirium syndrome.
No full textTo access publisher's full text version of this article click on the hyperlink belowAims: In typical arrest-related death (ARD) scenarios, the victims often show signs of excited delirium syndrome (ExDS), intoxication, exhaustion and/or suffered from a preexisting physical or psychiatrical condition, all of which could have caused or at least triggered the person's death. Since autopsy findings are very rare in such cases, a clear clinicopathologic diagnosis and thus mechanism of death is rarely found.
Methods: We present a case of a 25-year old woman, who died while being arrested by the police. Based on the patient's medical history, autopsy findings, contradicting witness testimonies, and reliable clinical and toxicological blood parameters, the most probable diagnosis is discussed.
Results: The cause of death was determined as cardiac arrest subsequent to a combination of excited delirium syndrome, physical exhaustion and respiratory impairment. The manner of death was unnatural and juridically, the charges were dropped.
Conclusions: In cases, where the cause and mechanism of death can only be diagnosed by exclusion, police collaboration, detailed clinical history (past and present) as well as clinical blood parameter analyses are necessary to help evaluating possible contributing factors and the most probable cause of death in ARD.
Keywords: Amphetamine; Arrest-related death; Asphyxia; Excited delirium syndrome; Forensic medicine; Restraint
Hreyfiseðillinn og störf sjúkraþjálfara innan heilsugæslunnar
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloa
Endurhæfing alla leið
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloa