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Reply to Amit Bansal, Ruchir Maheshwari, and Anant Kumar's Letter to the Editor re: Fredrik Liedberg, Petter Kollberg, Marie Allerbo, et al. Preventing Parastomal Hernia After Ileal Conduit by the Use of a Prophylactic Mesh: A Randomised Study. Eur Urol 2020;78:757-63.
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Low levels of respiratory syncytial virus activity in Europe during the 2020/21 season: what can we expect in the coming summer and autumn/winter?
No full textTo access publisher's full text version of this article click on the hyperlink belowSince the introduction of non-pharmacological interventions to control COVID-19, respiratory syncytial virus (RSV) activity in Europe has been limited. Surveillance data for 17 countries showed delayed RSV epidemics in France (≥ 12 w) and Iceland (≥ 4 w) during the 2020/21 season. RSV cases (predominantly small children) in France and Iceland were older compared with previous seasons. We hypothesise that future RSV epidemic(s) could start outside the usual autumn/winter season and be larger than expected. Year-round surveillance of RSV is of critical importance.
Keywords: COVID-19 pandemic; RSV; Respiratory syncytial virus; epidemiology; surveillance data.Sanofi Pasteur
AstraZenec
Evaluation and management of wilderness injuries and acute illness in Iceland during the years 2017-2018
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 DownloadBAKGRUNNUR
Slysavarnafélagið Landsbjörg (SL) eru öflug sjálfboðaliðasamtök sem
sinna um 1200 útköllum á ári hverju. Hluti þeirra útkalla varðar björgun
slasaðra eða veikra einstaklinga. Ekki liggja fyrir rannsóknir á þeirri
þjónustu sem SL veitir við þessar aðstæður.
MARKMIÐ
Markmið rannsóknarinnar var að afla upplýsinga um heilbrigðisþjónustu
sem SL veitti á árunum 2017-2018, hvort um slys eða veikindi var að
ræða, hvort veitt hafi verið viðeigandi meðferð á vettvangi og hver afdrif
einstaklinganna voru.
EFNIVIÐUR OG AÐFERÐIR
Upplýsingar voru fengnar úr rafrænum aðgerðagrunni SL. Skoðuð voru
þau tilvik þar sem fólk þurfti flutning og meðferð á heilbrigðisstofnun. Út
frá Björgum, skráningarkerfi Neyðarlínu, var hægt að nálgast kennitölur
og voru endanlegar greiningar og afdrif viðkomandi fengnar úr SÖGUkerfi og Heilsugátt.
NIÐURSTÖÐUR
Alls voru 189 aðgerðir teknar inn í rannsóknina með 239 manns.
Flestar aðgerðir voru skráðar á Suðurlandi. Í rúmlega helmingi tilfella
var um karlmenn að ræða og meðalaldur var 44,4 ár. Slys voru mun
algengari en veikindi, eða 86% tilvika. Algengast var að fólki skrikaði
fótur, hrasaði eða félli sem leiddi til áverka á neðri útlim. Af þeim sem
veiktust voru hjartatengd vandamál algengust. Í yfir 70% aðgerða var ekki
skráð rafrænt hvaða meðferð var beitt á vettvangi eða hvaða búnaður var
notaður.
ÁLYKTANIR
Björgunarsveitir þurfa reglulega að veita heilbrigðisþjónustu. Algengast
er að björgunarsveitir sinni einstaklingum eftir slys sem oftast verða á
neðri útlim. Veikindi sem sinnt er af björgunarsveitum eru oftast tengd
hjartasjúkdómum. Skráning á notkun búnaðar og meðferðar á vettvangi er
ónákvæm og má bæta.INTRODUCTION: In Iceland, wilderness search and rescue services are provided by
volunteer members of the Icelandic association for search and rescue (ICE-SAR). The
rescue teams respond to about 1200 calls every year, with a significant proportion of them
involving injured and sick individuals. No previous studies have been done on the service
provided by ICE-SAR teams. The aim of this study was to obtain information about the
health services provided by ICE-SAR in Iceland.
MATERIAL AND METHODS: Data was obtained from the ICE-SAR‘s and the National
emergency call service‘s (112) databases. Cases that occurred during the years 2017 and
2018 that required transfer and treatment at a health clinic or hospital were included in
the study. All cases with no involvement of sick or injured and minor injuries managed
on scene without tranport were excluded. Treatment on scene and during transport and
preliminary diagnosis made by ICE-SAR teams was reviewed. The medical report at
each treating medical facility in Iceland was reviewed for treatment provided and final
diagnosis.
RESULTS: A total of 189 operations with 239 individuals were included in the study. A
majority of the operations were recorded in the South region of Iceland. The average age of
individuals was 44,4 years, just over half of cases involving men. Accidents accounted for
86% of all cases where the most common incident was a fall resulting in lower extremity
injury. Cardiac disease was the most common cause for acute medical illness. On-scene
treatment and use of equipment was not recorded in over 70% of cases.
CONCLUSION: The ICE-SAR teams provide health care on regular basis, most commonly
after accidents involving the lower extremities. Illness treated by the ICE-SAR volunteers
most commonly involves cardiac symptoms. Documentation of on-site treatment and
equipment use is incomplete
Nurses’ and midwives’ attitudes towards family nursing at Akureyri Hospital (SAk)
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 DownloadFjölskylduhjúkrun bætir samskipti innan fjölskyldu, hefur
áhrif á gæði hjúkrunar og verkferla á sjúkradeildum,
eykur samvinnu við fjölskyldur, leiðir til styttri innlagna
og getur jafnvel komið í veg fyrir endurinnlagnir. Viðhorf
hjúkrunarfræðinga geta haft áhrif á það hvort og hvernig þeir
veita fjölskylduhjúkrun. Tilgangur rannsóknarinnar var að
meta og dýpka skilning á viðhorfum hjúkrunarfræðinga og
ljósmæðra á Sjúkrahúsinu á Akureyri til fjölskylduhjúkrunar
fyrir og á meðan á innleiðingu á Calgary fjölskylduhjúkrunar
stóð.
Rannsóknin var íhlutunarrannsókn án samanburðarhóps. Í
megindlega hlutanum svöruðu þátttakendur spurningalista
um viðhorf hjúkrunarfræðinga til mikilvægis fjölskyldna
í hjúkrun (FINC-NA – Families’ Importance in Nursing
Care – Nurses’ Attitudes) ásamt bakgrunnsspurningum.
Rannsóknargögnum og bakgrunnsupplýsingum var safnað
hjá öllum hjúkrunarfræðingum og ljósmæðrum á SAk á
tveimur tímabilum. Í megindlega hlutanum var unnið með
gögn hjúkrunarfræðinga og ljósmæðra á deildum þar sem
fjölskylduhjúkrun var innleidd (n=145). Á tíma 1 svöruðu 133
þátttakendur (92%) og á tíma 2 svöruðu 132 (89%). Úrvinnsla
megindlegra gagna fór fram í SPSS. Í eigindlega hlutanum
svöruðu þátttakendur þremur opnum spurningum skriflega.
Af öllu þýðinu (N=205) svöruðu 87 þátttakendur skriflega
spurningum við báðar fyrirlagnir sem voru greindar og
flokkaðar með aðferðum innihaldsgreiningar.
Viðhorf hjúkrunarfræðinga og ljósmæðra á SAk til fjölskylduhjúkrunar
var almennt jákvætt. Það breyttist ekki í
innleiðingarferlinu. Þátttakendur með hærra menntunarstig
og lengri starfsreynslu litu síður á fjölskyldu sem byrði
(p<0,05). Þátttakendur sem töldu að það væri almenn stefna
að hlúa að fjölskyldum á sinni deild höfðu jákvæðara viðhorf
(p<0,05). Þátttakendur töldu helsta ávinning og hvata
fjölskylduhjúkrunar stuðla að auknum gæðum hjúkrunar.
En hins vegar töldu þeir helstu hindranir í því að veita
fjölskylduhjúkrun vera álagsþættir í starfi, starfsumhverfi
og vinnuskipulagi.
Það er mikilvægt að styðja áfram við jákvæðviðhorf
hjúkrunarfræðinga og ljósmæðra á SAk til fjölskylduhjúkrunar.
Það hefur sýnt sig að jákvætt viðhorf stuðlar
að árangursríkari fjölskylduhjúkrun til sjúklinga og
aðstandenda.Family nursing improves communication within
the family, the quality of nursing practice
and work processes in hospitals, enhances
collaboration with families and can influence
length-of-stay and re-admissions. Nurses’
attitudes can affect whether and how they include
family care in their nursing. The main objective
was to assess and increase the understanding
of the attitudes of nurses and midwives at
Akureyri Hospital (SAk) toward the importance of
involving families in their care, before and while
implementing Calgary family nursing.
The quantitative part of this research was an
intervention study without a control group.
The participants answered the questionnaire
“Families’ Importance in Nursing Care – Nurses’
Attitudes” (FINC-NA) and background questions.
Data analysis was conducted on data from nurses/
midwives working on units where family nursing
was implemented (n=145). In time 1, 133 (92%)
participants answered the questionnaires and in
time 2, 132 (89%). Quantitative data was analysed
with SPSS. In the qualitative part the participants
answered in writing three open questions that 87
participants (N=205) responded to at both times.
The written answers were analysed with content
analysis.
The attitudes of nurses/midwives towards
families was generally positive. The attitudes did
not change during the implementation process.
Participants with a higher education level and
longer work experience, experienced family
less as a burden (p<0.05). Participants who
believed there was a general policy in their unit
to care for families had more positive attitudes
(p<0,05). Participants believed the benefits of
implementing family nursing into clinical practice
improves the quality of nursing care. It emerged
that the most significant hindrances in providing
family nursing were stress factors, nurses’ work
environment and work structure.
It is important to continue to support the nurses’
and midwives’ positive attitudes towards families
at SAk. Research shows that positive attitudes can
promote effective family nursing.B-Vísindasjóður Félags íslenskra hjúkrunarfræðing
No association between relapse hazard and thiopurine methyltransferase geno- or phenotypes in non-high risk acute lymphoblastic leukemia: a NOPHO ALL2008 sub-study.
No full textTo access publisher's full text version of this article click on the hyperlink belowPurpose: 6-mercaptopurine(6MP)/methotrexate maintenance therapy is essential to reduce relapse of childhood acute lymphoblastic leukemia (ALL). Common germline variants in TPMT cause low activity of thiopurine methyltransferase (TPMT) and higher 6MP metabolite (TGN) levels. Higher levels of TGNs incorporated into DNA (DNA-TG) and low TPMT activity have previously been associated with a lower relapse risk. We explored if TPMT geno- or phenotype was associated with DNA-TG levels and relapse rate in NOPHO ALL2008.
Methods: TPMT genotype, repeated phenotyping, and DNA-TG measurements were collected in 918 children with non-high risk ALL (NOPHO ALL2008 maintenance therapy study). Maintenance therapy started with 6MP at 50 and 75 mg/m2 for TPMT heterozygous and wildtype patients and was adjusted to a target WBC of 1.5 - 3.0 × 109/L.
Results: Of 918 patients, 78 (8.5%) were TPMT heterozygous and 903 had at least one TPMT measurement (total 3063). Mean TPMT activities were higher with wildtype than heterozygous TPMT (N = 752, 16.6 versus 9.6 U/mL ery., p < 0.001). The 5-year cumulative incidence of relapse was 6.4% and 6.0% for TPMT heterozygous and wildtype patients, and there was no association between genotype and relapse rate (N = 918, hazard ratio = 1.01, 95% confidence interval [CI] 0.40 - 2.54, p = 0.98). Although TPMT heterozygous patients had higher DNA-TG (N = 548, median 760.9 [interquartile range (IQR) 568.7 - 890.3] versus 492.7 [IQR 382.1 - 634.6] fmol/µg, p < 0.001), TPMT activity was not associated with relapse rate (N = 813; hazard ratio = 0.98 per one U/mL ery. increase in TPMT activity, 95% CI 0.91 - 1.06, p = 0.67).
Conclusion: TPMT geno- and phenotype were not associated with relapse in non-high risk NOPHO ALL2008.
Keywords: 6-mercaptopurine; Childhood acute lymphoblastic leukemia; Maintenance therapy; Relapse; Thiopurine methyltransferase.Danish Cancer Society
Childhood Cancer Foundation (Denmark)
Childhood Cancer Foundation (Sweden)
Nordic Cancer Union
Otto Christensen Foundation
University Hospital Rigshospitale
Novo Nordisk Foundatio
Increasing Incidences and Clonal Diversity of Methicillin-Resistant in the Nordic Countries - Results From the Nordic MRSA Surveillance.
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 DownloadMethicillin-resistant Staphylococcus aureus (MRSA) is notifiable in Denmark, Finland, Iceland, Norway and Sweden. The prevalence of MRSA in this region has been low for many years, but all five countries experience increasing numbers of new cases. The aim of the study was to describe the molecular epidemiology in the Nordic countries 2009-2016. Numbers of new cases of MRSA from 1997 to 2016 were compared, and a database containing information on spa-type and place of residence or acquisition, for all new MRSA isolates from 2009 to 2016 was established. A website was developed to visualize the geographic distribution of the spa-types. The incidence of new MRSA cases increased in all Nordic countries with Denmark having 61.8 new cases per 100,000 inhabitants in 2016 as the highest. The number of new cases 2009 to 2016 was 60,984. spa-typing revealed a high genetic diversity, with a total of 2,344 different spa-types identified. The majority of these spa-types (N = 2,017) were found in 1-10 cases. The most common spa-types t127/CC1, t223/CC22, and t304/CC6:8 increased significantly in all Nordic countries during the study period, except for Iceland, while spa-type t002/CC5 decreased in the same four countries. The trends of other common spa-types were different in each of the Nordic countries. The Nordic countries were shown to share similar trends but also to have country-specific characteristics in their MRSA populations. A continued increasing numbers of MRSA will challenge the surveillance economically. A more selected molecular surveillance will probably have to be employed in the future.Svenska Lakarsallskape
Effect of replacing ambulance physicians with paramedics on outcome of resuscitation for prehospital cardiac arrest.
No full textTo access publisher's full text version of this article click on the hyperlink belowIntroduction: Limited evidence suggests that the presence of a prehospital physician improves survival from cardiac arrest. A retrospective study is undertaken to examine this question. In Reykjavik, Iceland, prehospital physicians on ambulances were replaced by emergency medical technicians (EMTs) in 2007. The aim of this study is to compare the outcome of prehospital resuscitation from cardiac arrest during periods of time with and without prehospital physician involvement.
Methods: All cardiac arrests that underwent prehospital resuscitation by emergency medical systems between 2004 and 2014 were included. The primary outcome was survival to hospital discharge, and the secondary outcome was return of spontaneous circulation (ROSC). Subgroup analyses were performed according to the type of cardiac arrest.
Results: A total of 471 cardiac arrests were included for analysis, 200 treated by prehospital physicians from 2004 to 2007 and 271 treated by EMTs from 2008 to 2014. The overall rate of survival to hospital discharge and ROSC was 23 and 50% during the study period. No significant difference was observed in the rate of survival to hospital discharge [25 vs 22%, difference 3% (95% confidence interval (CI): 11-5%)] or ROSC [53 vs 47%, difference -6% (95% CI: 15-3%)] between these two time periods. In the subgroup of patients with pulseless electrical activity, survival to hospital discharge did not differ between the two periods, but the rate of ROSC was higher in the 'physician period' [50 vs 30%, difference -20% (95% CI: -40 to -1%)].
Conclusions: The presence of a prehospital physician on the ambulance was not found to result in a significant improvement in survival or ROSC after cardiac arrest compared to care by EMTs. Patients with pulseless electrical activity experienced an increase in ROSC when a physician was present but without improvement in survival to hospital discharge
Database Studies on Drug-Induced Liver Injury: The Importance of Causality Assessment.
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Are the target exposure index and deviation index used efficiently?
No full textTo access publisher's full text version of this article click on the hyperlink belowExposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently.Introduction: Exposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently.
Methods: Radiography departments in Iceland, using <10 years old equipment, were invited to participate. For each x-ray unit, admin users were asked about the use of EIT and data was gathered on EIT for five body parts (BP); lumbar spine, chest, hip, knee and hand. For each of the five BP, 100 examinations from the past year were selected randomly (or all, if < 100). The EI from one predefined view was recorded and the corresponding DI calculated.
Results: A total of ten x-ray units, from four manufacturers and located at eight departments, were included in the study. The departments involved are comprised of a university hospital, smaller hospitals, and miscellaneous private departments. Two departments (25%) had not set EIT, five (62.5%) used default values and only one had revised EIT values. In four departments (50%) radiographers favored "acceptable EI range" over DI. The mean EI was significantly different (p < 0.05) from the EIT in the majority of the five BP, in four out of the six departments that had defined EIT. In total 30% of images from all departments combined had DI outside the range of -3.0 < DI < +3.0. The standard deviation of DI was from 1.4 to 2.7.
Conclusion: The study shows that the EIT and DI are not used efficiently, regardless of equipment vendor or department characteristics.
Implications for practice: Current recommendations on targeting the mean DI of 0 need to be reinforced. Theoretical knowledge and training need to be improved.
Keywords: Digital radiography; Dose indicator; Dose optimization; Radiation exposure
Children may need higher vancomycin doses to achieve therapeutic levels.
No full textTo access publisher's full text version of this article click on the hyperlink belowAim: Vancomycin is frequently used in paediatric hospitals. Data suggest trough levels of 10-20 mg/L are needed to achieve bacterial killing. This study aimed to evaluate if commonly used dosing regimens are efficient in reaching these levels and if therapeutic drug monitoring (TDM) was appropriately used.
Methods: All children receiving intravenous vancomycin at the Children´s Hospital Iceland between 2012 and 2016 were included. Vancomycin trough levels were registered. Student t test, Wilcoxon test and regression models were used for statistical analysis.
Results: A total of 105 children received 163 vancomycin treatments (55/105 neonates). Average daily dose in neonates was 23.4 mg/kg/day and 38.4 mg/kg/day for older children. No TDM was done in 58 treatments (35.6%). First trough levels were <10mg/L in 52.4% and <15mg/L in 92% of cases. Therapeutic levels were less likely achieved in children with malignancy (11.8%) compared with others (36.8%, p = 0.09).
Conclusions: In more than half of the cases, trough drug levels were <10 mg/L and malignancy was associated with the lowest probability of reaching therapeutic levels. This study suggests that starting doses of vancomycin in children should be higher, especially in relation to malignant diseases and supports the importance of antibiotic stewardship to ensure optimal antibiotic use.
Keywords: children; empiric treatment; malignancy; therapeutic drug monitoring; vancomycin