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Saga hjúkrunarskráningar á Íslandi - Aðdragandi að stofnun rannsókna- og þróunarseturs um ICNP
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Pharmacokinetics of single and repeated oral doses of esomeprazole and gastrin elevation in healthy males and females.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: Gastrin elevation secondary to proton pump inhibitor (PPI) therapy is well documented. Recent studies have demonstrated a sex-related difference where females on PPIs have significantly higher baseline gastrin levels than males. The aim of the study was to analyse the pharmacokinetics of esomeprazole and short-term effect on serum gastrin levels and evaluate potential sex-related difference.
Materials and methods: Healthy volunteers received 40 mg of esomeprazole daily for five days. After the 1st and 5th dose blood samples for fasting gastrin and pharmacokinetic analysis were collected at scheduled time-points for eight hours. Esomeprazole was analysed by liquid chromatography and gastrin concentrations were measured using radioimmunoassay.
Results: A total of 30 volunteers were enrolled. Females had higher median baseline gastrin (pM) than males 12 (IQR 10-15) vs. 7 (IQR 4-11) (p = .03). In the study cohort, median gastrin levels rose from 10 (IQR 6-14) to 15 (IQR 13-20) (p = .0002). The serum levels for esomeprazole increased by an average of 299.8 ng/mL (p < .001) from day 1 to day 5. Comparison of the esomeprazole pharmacokinetic parameters between males and females revealed no significant sex-related differences. No significant correlation was found between the AUC and the gastrin level on day 5 (p = .15).
Conclusions: In healthy volunteers, serum gastrin increased significantly after a four-day PPI-therapy. There was also a significant increase in serum esomeprazole from day 1 to day 5. The increase in gastrin and esomeprazole concentration was not related to sex and no significant sex-related difference was found in terms of pharmacokinetic parameters. European Clinical Trial Database (2015-002230-41).
Keywords: Proton pump inhibitors; area under the serum concentration curve; gastrin; pharmacokinetics; pharmacology; sex-related difference
Professional versus public attitudes towards criminal charges in healthcare – registered nurses and a random national panel compared: Dark clouds on the horizon?
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Markmið rannsóknarinnar er að stuðla að upplýstri umræðu um öryggi
sjúklinga og viðbrögð við óvæntum atvikum í heilbrigðisþjónustu. Í
þessum tilgangi leitast rannsóknin við að varpa ljósi á þá spurningu
hvað einkenni viðhorf til þess hvort kæra eigi fyrir slík atvik eða ekki.
Tildrögin eru ákæra fyrir manndráp af gáleysi á hendur hjúkrunarfræðingi í maí 2014 og áhrif þeirrar ákæru á heilbrigðisstarfsfólk.
EFNIVIÐUR OG AÐFERÐIR
I þessari lýsandi samanburðarrannsókn var kannað hvort munur væri
á viðhorfum til ákæru vegna atvika í heilbrigðisþjónustu milli slembiúrtaks úr Þjóðskrá (Þjóðgátt) og allra félagsmanna í Félagi íslenskra
hjúkrunarfræðinga. Báðir hópar voru spurðir hvort ákæra ætti heilbrigðisstarfsmann sem veldur alvarlegum skaða eða andláti vegna
mannlegra mistaka, slysni, vanrækslu eða af ásetningi. Svör voru gefin
á Likert- kvarða.
NIÐURSTÖÐUR
Marktækur munur reyndist á svörum hópanna um það hvort ákæra
ætti fyrir skaða eða andlát af völdum mannlegra mistaka eða slysni,
þar sem hjúkrunarfræðingar voru líklegri til að vera mjög eða frekar
ósammála ákæru en Þjóðgáttarhópurinn var líklegri til að vera mjög
eða frekar sammála. Munurinn milli hópanna minnkaði með hærra
menntunarstigi Þjóðgáttarhópsins. Þegar spurt var um hvort ákæra
ætti heilbrigðisstarfsmann fyrir skaða eða andlát vegna vanrækslu eða
ásetnings var munurinn ekki marktækur.
ÁLYKTANIR
Niðurstöður rannsóknarinnar benda til þess að viðhorf hjúkrunarfræðinga endurspegli ekki tilhneigingu til að víkjast undan ábyrgð á
óvæntum atvikum í heilbrigðisþjónustu, heldur mikilvægi þess að gera
greinarmun á eðli slíkra atvika. Þessar niðurstöður sýna að þörf er á
upplýstri opinni umræðu um óvænt atvik í heilbrigðisþjónustu og viðeigandi ráðstafanir og viðbrögð sem best tryggja öryggi bæði sjúklinga
og starfsfólkINTRODUCTION: The aim of this study is to encourage a discussion on patient
safety and public responses to serious incidents in healthcare. Triggered by the
first of its kind in Iceland, it addresses the question what characterizes attitudes
towards criminal charges for a serious incident in healthcare.
MATERIAL AND METHODS: In this comparative study we examined whether attitudes towards culpability of healthcare professionals differed between cohorts from
a random national panel and registered Icelandic nurses. Both groups were asked
whether a healthcare professional should face criminal charges if causing serious
harm or death due to human error, accident, neglect or intent. Answers were given
on a Likert scale.
RESULTS: When asked if a healthcare professional causing serious harm or death
due to human error or by accident should face criminal charges, nurses were
significantly more likely to somewhat or strongly disagree, while the panel was
significantly more likely to somewhat or strongly agree. The difference was inversely proportional to educational levels among the panel members. When asked
whether a healthcare professional should be charged for causing serious harm
or death due to neglect or intent, there was no significant difference between the
groups.
CONCLUSION: The results indicate that healthcare professionals, as represented
by Icelandic nurses, do not seek to avoid accountability in serious patient incidents,
but implicate the importance of distinguishing between the different nature of
incidents. The results show that a more informed public debate on serious healthcare incidents is needed in which appropriate measures protecting patient safety
as well as professional safety are ensured.Heilbrigðisráðuneyti
Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study.
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: Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates.
Design: Observational study using routine data.
Setting: Twenty-seven EU member states plus Iceland, Norway, Switzerland and the UK.
Population: All births at ≥22 weeks of gestational age in 2015.
Methods: National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups.
Main outcome measures: Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups.
Results: Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions.
Conclusions: Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence-based caesarean policies.
Tweetable abstract: Many European countries can provide Robson's Ten-Group Classification to improve caesarean rate comparisons.
Keywords: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators.InfAct Joint Action
Bridge Health Project, Public Health Programme, Consumers, Health, Agriculture and Food Executive Agency (CHAFEA
Ritstjóraspjall
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Meðferð sjúklinga fyrstu þrjá sólarhringana eftir blóðþurrðarslag í heila. Hlutverk hjúkrunarfræðinga í skimun á hita, blóðsykri og kyngingu: Fræðileg samantekt
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 DownloadÍ þessari grein verður fjallað um helstu orsakir og einkenni blóðþurrðarslags og hvað það er
sem gerist í heilanum þegar einstaklingur færslag. Heilbrigðisstafsmenn nota oft orðatiltækið
,,tímatap er heilatap“, en hvaða merkingu hefur það í raun og veru? Varpað verður ljósi á mikilvægi réttra viðbragða í bráðameðferð sem og mikilvægisérhæfðrar heilaslagseiningar. Rannsóknirsýna að sérhæft eftirlit og meðferð hjúkrunarfræðinga við hækkuðum hita og blóðsykri
í kjölfar heilaslags, ásamt því að bregðast við kyngingarerfiðleikum fyrstu þrjá sólarhringana
eftir áfallið, hefur jákvæð áhrif á batahorfursjúklinga. Til þess að efla þekkingu hjúkrunarfræðinga á þessum þáttum er stuðst við niðurstöður fræðilegrar samantekta
Prevalence of persistent physical symptoms and association with depression, anxiety and health anxiety in Iceland
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Þrálát líkamleg einkenni sem ekki eiga sér þekktar líkamlegar orsakir
geta skert færni til að sinna athöfnum daglegs lífs. Markmið rannsóknarinnar var að meta algengi slíkra einkenna meðal fólks sem
sækir heilsugæsluþjónustu á höfuðborgarsvæðinu, tengsl þeirra við
færniskerðingu og einkenni þunglyndis, almenns kvíða og heilsukvíða,
og meta hlutfall sjúklinga sem líklega hafi gagn af sálfræðimeðferð við
þrálátum líkamlegum einkennum.
EFNIVIÐUR OG AÐFERÐIR
Spurningalistar sem meta þrálát líkamleg einkenni, færniskerðingu og
einkenni þunglyndis, almenns kvíða og heilsukvíða voru lagðir fyrir 106
þátttakendur á tveimur heilsugæslustöðvum á höfuðborgarsvæðinu.
NIÐURSTÖÐUR
Tuttugu og níu (27,4%) þátttakendur reyndust vera með þrálát líkamleg
einkenni og voru sterk tengsl á milli þeirra og einkenna geðraskana.
Þátttakendur með þrálát líkamleg einkenni voru 8 sinnum líklegri til
að vera með einkenni þunglyndis og almenns kvíða en þátttakendur
án þeirra, fjórum sinnum líklegri til að vera með einkenni heilsukvíða
og 13 sinnum líklegri til að vera með færniskerðingu yfir klínískum
viðmiðunarmörkum. Rúmlega helmingur þátttakenda með þrálát
líkamleg einkenni voru með tvær eða fleiri gerðir einkenna en þreyta
og vöðvavandamál var algengasta gerðin. 65% þátttakenda greindu frá
þrálátum líkamlegum einkennum og sálrænum einkennum yfir klínískum viðmiðunarmörkum.
ÁLYKTUN
Algengi þrálátra líkamlegra einkenna meðal notenda heilsugæsluþjónustu á höfuðborgarsvæðinu samræmist niðurstöðum erlendra
rannsókna. Sama má segja um tengsl þeirra við einkenni þunglyndis
og kvíða. Líklegt er að tveir þriðju heilsugæslusjúklinga með slík
einkenni myndu njóta góðs af sálfræðilegri meðferð. Hugræn atferlismeðferð við þrálátum líkamlegum einkennum gæti gert þessum hópi
gagn en í slíkri meðferð er unnið sérstaklega með samspil sálrænna
og líkamlegra einkennaINTRODUCTION: Persistent physical symptoms that are medically unexplained can result
in significant functional impairment. The aim of this study was to estimate the prevalence of
persistent physical symptoms among people seeking primary healthcare in Reykjavík, Iceland,
how they relate to functional impairment, symptoms of depression, general anxiety and health
anxiety, and estimate the proportion of people with such symptoms who would likely benefit
from psychological treatment.
MATERIALS AND METHODS: Questionnaires measuring persistent physical symptoms,
functional impairment, and symptoms of depression, general anxiety and health anxiety were
administered to 106 patients attending two primary healthcare clinics.
RESULTS: The prevalence of persistent physical symptoms was 27.4% among the primary care
patients and they had a strong relationship to symptoms of mental disorders. Participants with
persistent physical symptoms were 8 times more likely to have clinical levels of depression and
general anxiety than participants without such symptoms, 4 times more likely to have clinical
levels of health anxiety and 13 times more likely to have clinical levels of functional impairment.
At least two-thirds of participants with persistent physical symptoms would likely benefit from
psychological treatment.
CONCLUSION: The prevalence of persistent physical symptoms among health care patients
in the capital area of Iceland is in line with previous studies. Similarly, the strong relationship
between persistent physical symptoms and symptoms of depression and anxiety corresponds
to previous studies. It is likely that at least two out of three patients with persistent physical
symptoms would benefit from psychological treatment. Transdiagnostic cognitive behavioural
therapy for persistent physical symptoms might be particularly useful as is focuses on the
interplay between physical and mental symptoms
Changes in sleepiness and 24-h blood pressure following 4 months of CPAP treatment are not mediated by ICAM-1.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: Continuous positive airway pressure (CPAP) therapy reduces circulating intercellular adhesion molecule 1 (ICAM-1) in adults with obstructive sleep apnea (OSA). ICAM-1 levels may affect the daytime sleepiness and elevated blood pressure associated with OSA. We evaluated the association of changes from baseline in ICAM-1 with changes of objective and subjective measures of sleepiness, as well as 24-h ambulatory blood pressure monitoring (ABPM) measures, following 4 months of CPAP treatment.
Methods: The study sample included adults with newly diagnosed OSA. Plasma ICAM-1, 24-h ABPM, Epworth Sleepiness Scale (ESS), and psychomotor vigilance task (PVT) were obtained at baseline and following adequate CPAP treatment. The associations between changes in natural log ICAM-1 and changes in the number of lapses on PVT, ESS score, and 24-h mean arterial blood pressure (MAP) were assessed using multivariate regression models, controlling for a priori baseline covariates of age, sex, BMI, race, site, smoking status, physical activity, anti-hypertensive medications, AHI, and daily hours of CPAP use.
Results: Among 140 adults (83% men), mean (± SD) body mass index (BMI) was 31.5 ± 4.2 kg/m2, and apnea-hyopnea index (AHI) was 36.8 ± 15.3 events/h. Sleepiness measures, although not ICAM-1 or ABPM measures, improved significantly following CPAP treatment. We observed no statistically significant associations between the change in ICAM-1 and changes in sleepiness, MAP, or other ABPM measures.
Conclusion: Changes in ICAM-1 levels were not related to changes in sleepiness or ABPM following CPAP treatment of adults with OSA. Future work should explore whether or not other biomarkers may have a role in mediating these treatment outcomes in adults with OSA.
Keywords: Ambulatory blood pressure monitoring; Continuous positive airway pressure; Intercellular adhesion molecule-1; Obstructive sleep apnea; Sleepiness.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Heart Lung & Blood Institute (NHLBI
The design of RIP belts impacts the reliability and quality of the measured respiratory signals.
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 DownloadPurpose: Evaluate the effect of respiratory inductance plethysmography (RIP) belt design on the reliability and quality of respiratory signals. A comparison of cannula flow to disposable cut-to-fit, semi-disposable folding and disposable RIP belts was performed in clinical home sleep apnea testing (HSAT) studies.
Methods: This was a retrospective study using clinical HSAT studies. The signal reliability of cannula, thorax, and abdomen RIP belts was determined by automatically identifying periods during which the signals did not represent respiratory airflow and breathing movements. Results were verified by manual scoring. RIP flow quality was determined by examining the correlation between the RIP flow and cannula flow when both signals were considered reliable.
Results: Of 767 clinical HSAT studies, mean signal reliability of the cut-to-fit, semi-disposable, and disposable thorax RIP belts was 83.0 ± 26.2%, 76.1 ± 24.4%, and 98.5 ± 9.3%, respectively. The signal reliability of the cannula was 92.5 ± 16.1%, 87.0 ± 23.3%, and 85.5 ± 24.5%, respectively. The automatic assessment of signal reliability for the RIP belts and cannula flow had a sensitivity of 50% and a specificity of 99% compared with manual assessment. The mean correlation of cannula flow to RIP flow from the cut-to-fit, semi-disposable, and disposable RIP belts was 0.79 ± 0.24, 0.52 ± 0.20, and 0.86 ± 0.18, respectively.
Conclusion: The design of RIP belts affects the reliability and quality of respiratory signals. The disposable RIP belts that had integrated contacts and did not fold on top of themselves performed the best. The cut-to-fit RIP belts were most likely to be unreliable, and the semi-disposable folding belts produced the lowest-quality RIP flow signals compared to the cannula flow signal.
Keywords: Obstructive sleep apnea (OSA); Respiratory airflow; Respiratory inductance plethysmography (RIP) belts; Signal quality; Signal reliability.Icelandic Research Fund
Horizon 2020 grant (H2020-SMEINST-2-2016-2017
Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD).
No full textTo access publisher's full text version of this article click on the hyperlink belowObjectives: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.
Methods: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.
Results: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001).
Conclusions: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.
Keywords: Acute type A aortic dissection; Cardiac surgery; Cerebral malperfusion; Stroke