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Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjectives: Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population.
Methods: A retrospective, nationwide cohort study, which included 114676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0-18.9).
Results: Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P < 0.001) and at 1 year (12.8% vs 4.5%, P < 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8-3.9] at 90 days and 4.7% (95% CI: 2.6-6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38-2.59)], 1-year [aRR 2.13 (95% CI: 1.68-2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30-1.88)].
Conclusions: Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.
Keywords: Cardiac surgery; Deep sternal wound infection; Incidence; Mediastinitis; Mortality.Swedish Heart-Lung Foundation
Swedish government
Swedish county councils concerning economic support of research and education of doctors (ALF agreement) ALFGBG-725131
Vastra Gotaland Region
University of Iceland Research Fund
Landspitali University Research Fund
Nils Winbergs fon
Genetic propensities for verbal and spatial ability have opposite effects on body mass index and risk of schizophrenia
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 DownloadWe generated two polygenic scores, one capturing verbal and the other spatial aspects of cognitive ability, using UK Biobank data and studied their effects on various diseases and other traits in the Icelandic population. The score tagging spatial ability associated with higher body mass index (β = 0.032, p = 3.2 × 10−13), but lower risk of schizophrenia (OR = 0.82, p = 8.8 × 10−9) and other mental disorders. Furthermore, it associated with less openness, a personality trait reflecting curiosity and creativity (β = −0.023, p = 1.3 × 10−4). Conversely, the score tagging verbal ability associated with lower body mass index (β = −0.023, p = 1.6 × 10−7) and more openness (β = 0.045, p = 3.5 × 10−14), but did not associate with risk of schizophrenia (OR = 0.97, p = 0.42). Furthermore, applying genomic structural equation modeling, we observed that the genetic component of verbal ability associated positively with the genetic component of schizophrenia after conditioning on the g factor (bg = 0.193, p = 5.4 × 10−4). Thus, at the genetic level, verbal and spatial ability exhibit contrasting associations with indicators of mental and physical health, as well as with personality.Horizon 202
Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences.
Full text linkTo 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 DownloadAims and objectives: This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).
Background: In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved.
Design: This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.
Methods: Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.
Results: The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care.
Conclusions: The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'.
Relevance to clinical practice: There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.
Keywords: family-centred care; neonatal care; nurse-patient relationship; qualitative study; support
The incidence of sinus thrombosis in Iceland 2008-2020
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 DownloadINNGANGUR
Stokkasegi er orsök um 0,5-1% allra heilablóðfalla. Stokkasegi getur
valdið blæðingu og/eða heiladrepi auk hækkaðs innankúpuþrýstings. Erfitt
getur reynst að greina stokkasega vegna fjölbreyttra einkenna og erfiðrar
myndgreiningar á köflum. Markmið rannsóknarinnar var að rannsaka
nýgengi stokkasega á Íslandi á tímabilinu 2008-2020, áhættuþætti,
einkenni, meðferð og horfur.
EFNIVIÐUR OG AÐFERÐIR
Framkvæmd var lýsandi afturskyggn rannsókn án viðmiðunarhóps
þar sem upplýsingum úr sjúkraskrám einstaklinga sem greindust
með stokkasega á tímabilinu frá 1. janúar 2008 til 31. desember 2020
var safnað. Eftirfarandi þættir voru skoðaðir: kyn, greiningarár, aldur
við greiningu, einkenni, þekktir áhættuþættir, rannsóknarniðurstöður,
meðferðir og afdrif. Úrvinnsla fór fram í Excel og Rstudio.
NIÐURSTÖÐUR
Alls greindist 31 einstaklingar (22 konur). Meðalnýgengið var
0,72/100.000 manns á ári. Meðalaldur var 34,3 ár (14-63 ára). Algengasta
einkennið var höfuðverkur (87%), önnur voru staðbundin taugaeinkenni,
flog og skert meðvitund. Algengasti áhættuþátturinn meðal kvenna var
notkun getnaðarvarnarlyfja (73%). Fjórir sjúklingar höfðu engan þekktan
áhættuþátt. Í 74% tilfella var seginn í þverstokki. Stokkasegi var í tveimur
eða fleiri bláæðastokkum í 58% tilfella. Allir sjúklingarnir voru settir á
blóðþynningarmeðferð. Langoftast var byrjað á heparíni/léttheparíni og
síðan tók við meðferð á warfaríni eða NOAC-lyfjum. Eftir þrjá mánuði
mældust 87% sjúklinganna með 0-2 á modified Rankin-skalanum (mRS)
og höfðu því enga eða væga fötlun eftir stokkasegann. Einn sjúklingur lést
vegna stokkasega.
ÁLYKTANIR
Nýgengi stokkasega á Íslandi er í samræmi við erlendar rannsóknir.
Höfuðverkur var algengasta einkennið og getnaðarvarnarlyf algengasti
áhættuþátturinn meðal kvenna. Flestir sjúklinganna náðu góðum bata
sem bendir til tímanlegrar greiningar og viðeigandi meðferðar á Íslandi.BACKGROUND: Cerebral venous sinus thrombosis (CSVT) is the cause of 0.5%-1% of all strokes.
CSVT can cause haemorrhage, cerebral infarction and increased intracranial pressure. Due
to a variety of symptoms, CSVT can be difficult to diagnose. The purpose of this study was to
examine the incidence of CSVT in Iceland 2008-2020, risk factors, symptoms, treatment and
outcome.
METHODS: A retrospective reviewing of medical records of those diagnosed with CSVT from 1.
January 2008 to 31. December 2020, was performed. Sex, age at diagnosis, symptoms, known
risk factors, imaging results, treatment and outcome were studied. Statistical processing was
performed with Excel and Rstudio.
RESULTS: Overall, 31 patients were diagnosed with CSVT (22 women). The mean incidence was
0.72/100.00 per year. The mean age was 34.3 years (14-63 years). The most common symptom
was headache (87%), other symptoms included focal symptoms and seizures. The most
common risk factor was the use of oral contraceptives (73%). Four patients had no risk factor.
The most commonly affected sinus was the transverse-sinus (74%). All patients were treated
with anticoagulants. Most received heparin or low-molecular-weight heparin then succeeded
by warfarin or NOACs. Three months after diagnosis, 87% of the patients scored 0-2 on the
modified Rankin Scale. One patient died as a result of CSVT.
DISCUSSION: The incidence of CSVT in Iceland is in accordance with other studies. Headache
was the most common symptom and oral contraceptives the most common risk factor
among women. Most patients made a good recovery, which suggests a timely diagnosis and
appropriate treatment for CSVT in Iceland
Taking phenomenology beyond the first-person perspective: conceptual grounding in the collection and analysis of observational evidence
Full text linkTo 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 DownloadPhenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. © 2021, The Author(s).
Author keywords
Embodiment; Hemispatial neglect; Observational research; Phenomenology; Qualitative method
Professional moral character of physicians and clinical working environment
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 DownloadINNGANGUR
Greint er frá niðurstöðum könnunar um reynslu og upplifun kandídata og
almennra lækna og reyndra sérfræðinga af klínísku starfi á Íslandi. Til
samanburðar var höfð samskonar rannsókn við breskar sjúkrastofnanir
þar sem reyndir sérfræðingar fengu spurningarnar. Rannsóknin beindist
að því hvernig starfsumhverfi lækna hefur áhrif á mannkosti þeirra,
upplifun af stuðningi, vinnuálagi, sjálfræði og tengingu við starfið.
EFNIVIÐUR OG AÐFERÐIR
Samtals 89 læknar tóku þátt og svöruðu 15 spurningum. Tíðni svara var
borin saman úr klösum fjögurra efnisflokka.
NIÐURSTÖÐUR
Niðurstöður bentu til markverðs vanda á vinnustöðum lækna hérlendis.
Upplifunin var neðarlega í öðrum fjórðungi (2,1-3,0) matsskala þess að
vinnuumhverfið hamli því að fagleg manngerð þeirra njóti sín. Einnig
vantaði upp á þætti stuðnings. Í samanburði við breska sérfræðinga
var upplifun þeirra sambærileg en þó skárri hvað stuðning varðaði.
Kandídatar og almennir læknar upplifa marktækt meiri streitu,
minni stuðning og sjálfræði í vinnu sinni en reyndu sérfræðingarnir
hérlendis. Í samanburði við bresku rannsóknina var upplifun íslensku
sérfræðilæknanna jákvæðari varðandi sjálfsákvörðun og tilfinningaleg
tengsl við starfið. Rannsókn okkar sýnir í fyrsta sinn samband
vinnuumhverfis og álags á mikilvæga fagtengda mannkosti lækna
hérlendis.
UMRÆÐA
Þessar niðurstöður endurspegla niðurstöður fræðigreina um mikilvægi
þess að læknar geti nýtt mannkosti sína í starfi, því þeir tengist
starfsánægju, langvarandi velfarnaði og tilfinningu fyrir tilgangi
starfsins. Niðurstöðurnar styðja viðhorf í skrifum lækna hérlendis um
óheyrilegt vinnuálag og manneklu. Rannsóknin sýnir upplifun lækna af
því hvar skóinn kreppir í starfi og mikilvægi þess að þjóðfélagið bæti
starfsskilyrðin til að gera þeim kleift að starfa eftir hugsjón sinni.INTRODUCTION. A survey of the experience of Icelandic medical candidates, general
physicians, and specialty physicians of clinical work, aimed to show how the working
environment affects doctors’ moral character and experience of support, well-being and
expectations. For comparison, results of a British survey with the same questions for
specialty physicians were used.
MATERIAL AND METHODS. A total of 89 physicians answered 15 questions. Statistical
comparison was made between results from topical clusters of questions.
RESULTS. The results show a significant problem in work conditions of Icelandic doctors.
Their experience is rated low in the second quarter (2,1 – 3,0) on a numerical scale of how
the environment thwarts professional character and of lack of support. In comparison with
British specialists, their experience is similar but slighly better regarding supportiveness.
Icelandic candidates and general physicians experience significantly more stress,
less support and autonomy in their work than specialists. Compared to the British, the
experience of Icelandic specialists was more positive about professional autonomy and
emotional attachment to the work. Our survey shows for the first time the effect of the
working environment on professional virtues of Icelandic doctors.
DISCUSSION. These findings resonate with the literature that the moral character of doctors
contributes to satisfaction, flourishing and experience of meaningfulness. They substantiate
views raised by Icelandic physicians about tremendous work stress and scarcity of staff.
The survey demonstrates the doctors‘ experience of work-related challenges and provides
reasons for society to improve their working conditions to enable them to live up to their
ideals
Technical Performance of Textile-Based Dry Forehead Electrodes Compared with Medical-Grade Overnight Home Sleep Recordings
Full text linkTo 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 DownloadThe current clinically used electroencephalography (EEG) sensors are not self-applicable. This complicates the recording of the brain's electrical activity in unattended home polysomnography (PSG). When EEG is not recorded, the sleep architecture cannot be accurately determined, which decreases the accuracy of home-based diagnosis of sleep disorders. The aim of this study was to compare the technical performance of FocusBand, an easily applicable textile electrode headband, to that of clinical EEG and electrooculography (EOG) electrodes. Overnight unattended recordings were conducted at participants' (n = 10) homes. Signals were recorded using a portable Nox A1 PSG device. The FocusBand's forehead EEG (Fp1-Fp2) signals contained features that are visible at both, the standard EEG (F4-M1) and EOG (E1-M2) signals. The FocusBand's EEG signal amplitudes were significantly lower compared to standard EEG (F4-M1; average difference 98%) and EOG (E1-M2; average difference 29%) signals during all sleep stages. Despite the amplitude difference, forehead EEG signals displayed typical EEG characteristics related to certain sleep stages. However, the frequency content of the FocusBand-based signals was more similar to that of the standard EOG signals than that of standard EEG signals. The majority of the artifacts seen in the FocusBand signals were related to a loosened headband. High differences in the frequency content of the compared signals were also found during wakefulness, suggesting susceptibility of the textile electrodes to electrode movement artifacts. This study demonstrates that the forehead biopotential signals recorded using an easily attachable textile electrode headband could be useful in home-based sleep recordings.European Union's Horizon 2020 Research and Innovation Programme
NordForsk through the Business Finland
NordForsk through Icelandic Center for Research
Academy of Finland
European Commission
Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding
Finnish Cultural Foundation
Finnish Cultural Foundation-Kainuu Regional Fund
Respiratory Foundation of Kuopio Region
Research Foundation of the Pulmonary Diseases
Finnish Anti-Tuberculosis Association
Tampere Tuberculosis Foundatio
Native joint infections in Iceland 2003-2017: an increase in postarthroscopic infections.
Full text linkTo 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 DownloadObjectives: Nationwide study on the epidemiology, clinical characteristics and outcomes among patients with native joint infection (NJI) in Iceland, 2003-2017.
Methods: All positive synovial fluid culture results in Iceland were identified and medical records reviewed.
Results: A total of 299 NJI (40 children and 259 adults) were diagnosed in Iceland in 2003-2017, with a stable incidence of 6.3 cases/100 000/year, but marked gender difference among adults (33% women vs 67% men, p<0.001). The knee joint was most commonly affected, and Staphylococcus aureus was the most common isolate in both adults and children, followed by various streptococcal species in adults and Kingella kingae in children. NJI was iatrogenic in 34% of adults (88/259) but comprised 45% among 18-65 years and a stable incidence. Incidence of infections following arthroscopic procedures in adults increased significantly compared with the previous decade (9/100 000/year in 1990-2002 vs 25/100 000/year in 2003-2017, p<0.01) with no significant increase seen in risk per procedure. The proportion of postarthroscopic NJI was 0.17% overall but 0.24% for knee arthroscopy. Patients with postarthroscopic infection were more likely to undergo subsequent arthroplasty when compared with other patients with NJI (p=0.008).
Conclusions: The incidence of NJI in Iceland has remained stable. The proportion of iatrogenic infections is high, especially among young adults, with an increase seen in postarthroscopic infections when compared with the previous decade. Although rare, NJI following arthroscopy can be a devastating complication, with significant morbidity and these results, therefore, emphasise the need for firm indications when arthroscopic treatment is considered.
Keywords: arthritis; epidemiology; health services research; infectious; orthopedic procedures.Science Fund, Landspitali University Hospita
An International Consensus List of Potentially Clinically Significant Drug-Drug Interactions in Older People.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjectives: We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years.
Design: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided.
Setting and participants: Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries.
Measures: For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round.
Results: Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs.
Conclusion and implications: We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.
Keywords: Delphi technique; aged; drug interactions.European Commission
Swiss State Secretariat for Education, Research, and Innovation (SERI)
Swiss National Science Foundation (SNSF
Developing a composite outcome tool to measure response to treatment in ANCA-associated vasculitis: A mixed methods study from OMERACT 2020.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group aims to develop composite response criteria for ANCA-Associated Vasculitis (AAV).
Methods: The project follows the OMERACT approach for composite measures: (i) choose relevant domains; (ii) define high-quality instruments; (iii) decide on a scoring system approach; (iv) put through the OMERACT Filter 2.1 for validation.
Results: A systematic literature review of outcome measures used in clinical trials in AAV and an international Delphi exercise among patients with AAV and clinician-investigators with expertise in AAV have been completed to inform the candidate domains/instruments for the composite response criteria, which are the first two steps in the OMERACT approach for developing composite measures. Results of the systematic literature review and Delphi were presented at the OMERACT 2020 virtual workshop, and feedback was received on the next steps of the project, including the development of a scoring system approach.
Conclusion: The ultimate goal of this project is to develop validated composite response criteria for use in clinical trials of AAV.
Keywords: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis; Composite measure; OMERACT; Outcome measures.General Electric
European League Against Rheumatis