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Lower or higher oxygenation targets for acute hypoxemic respiratory failure
No full textTo access publisher's full text version of this article click on the hyperlink belowBACKGROUND Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target. METHODS In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days. RESULTS At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P=0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P=0.24). CONCLUSIONS Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days
HLA-DQB1 6672G>C (rs113332494) is associated with clozapine-induced neutropenia and agranulocytosis in individuals of European ancestry.
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 DownloadThe atypical antipsychotic clozapine is the only effective medication for treatment-resistant schizophrenia. However, it can also induce serious adverse drug reactions, including agranulocytosis and neutropenia. The mechanism by which it does so is largely unknown, but there is evidence for contributing genetic factors. Several studies identified HLA-DQB1 variants and especially a polymorphism located in HLA-DQB1 (6672G>C, rs113332494) as associated with clozapine-induced agranulocytosis and neutropenia. We analysed the risk allele distribution of SNP rs113332494 in a sample of 1396 controls and 178 neutropenia cases of which 60 developed agranulocytosis. Absolute neutrophil counts of 500/mm3 and 1500/mm3 were used for defining agranulocytosis and neutropenia cases, respectively. We also performed association analyses and analysed local ancestry patterns in individuals of European ancestry, seeking replication and extension of earlier findings. HLA-DQB1 (6672G>C, rs113332494) was associated with neutropenia (OR = 6.20, P = 2.20E-06) and agranulocytosis (OR = 10.49, P = 1.83E-06) in individuals of European ancestry. The association signal strengthened after including local ancestry estimates (neutropenia: OR = 10.38, P = 6.05E-08; agranulocytosis: OR = 16.31, P = 1.39E-06), with effect sizes being considerably larger for agranulocytosis. Using local ancestry estimates for prediction, the sensitivity of rs113332494 increased from 11.28 to 55.64% for neutropenia and from 16.67 to 53.70% for agranulocytosis. Our study further strengthens the evidence implicating HLA-DQB1 in agranulocytosis and neutropenia, suggesting components of the immune system as contributing to this serious adverse drug reaction. Using local ancestry estimates might help in identifying risk variants and improve prediction of haematological adverse effects.European Union's Seventh Framework Programme for research, technological development and demonstration
UK Research & Innovation (UKRI)
Medical Research Council UK (MRC)
"Springboard" award from the Academy of Medical Sciences
Takeda Pharmaceutical Company Ltd
US National Institute of Mental Health via the American Recovery and Reinvestment Act of 2009
National Science Foundation (NSF
Diabetes: an increasing problem and novel drug treatment
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Parents’ view on home visits from nurses in well-childcare: Descriptive cross-sectional study
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: Heimavitjanir hjúkrunarfræðinga í ung- og smábarnavernd miða að því að veita foreldrum aðstoð og ráðgjöf eftir fæðingu
barns, á tíma sem oft er viðkvæmur foreldrunum. Tilgangur rannsóknarinnar var að varpa ljósi á viðhorf foreldra til heimavitjana
hjúkrunarfræðinga á vegum ung- og smábarnaverndar heilsugæslustöðva og meta hvort munur væri á viðhorfum foreldra með fyrsta
barn og þeirra sem höfðu eignast barn áður.
Aðferð: Lýsandi þversniðsrannsókn. Úrtakið voru foreldrar sem
komu með börn í sex og níu vikna skoðun á heilsugæslustöðvar á
höfuðborgarsvæðinu í upphafi árs 2020. Foreldrar sem samþykktu
þátttöku fengu sendan rafrænan spurningalista með 27 opnum og
lokuðum spurningum, 19 spurningum um heimavitjanir og átta
spurningum um bakgrunn þátttakenda.
Niðurstöður: Á rannsóknartímabilinu komu 390 börn í sex eða níu
vikna skoðun. Foreldrar 136 barna (35%) svöruðu öllum spurningunum. Af þeim voru 93% konur og rétt tæpur helmingur var að eignast sitt fyrsta barn (49%). Flestir foreldrarnir (92%) voru ánægðir
með heimavitjanir hjúkrunarfræðinga í ung- og smábarnavernd og
kunnu að meta ráðgjöf, aðstoð og stuðning sem hjúkrunarfræðingar
veittu þeim. Flestum fannst heimavitjanirnar hæfilega margar (84%)
og hæfilega langar (96%). Lítill hluti foreldra (8,1%) var óánægður
með heimavitjanir hjúkrunarfræðinga. Foreldrar með fyrsta barn
voru marktækt óánægðari með aðstoð og ráðgjöf sem þeir fengu í
heimavitjunum en foreldar sem höfðu eignast barn áður. Ekki var
marktækur munur á viðhorfum foreldra með fyrsta barn og þeirra
sem höfðu eignast barn áður varðandi tíðni eða lengd heimavitjana.
Ályktanir: Niðurstöðurnar benda sterklega til þess að heimavitjanir
hjúkrunarfræðinga í ung- og smábarnavernd séu mikilvægur þáttur
í þjónustu við nýbakaða foreldra. Meirihluti þátttakenda var ánægður
með heimavitjanir hjúkrunarfræðinga, fjölda þeirra og lengd en alltaf
má gera betur. Huga þarf sérstakalega að þörfum foreldra með fyrsta
barn þar sem þeir voru marktækt óánægðari með aðstoð og ráðgjöf
sem þeir fengu en foreldrar sem höfðu eignast barn áður.
Lykilorð: hjúkrunarfræðingar, heimavitjun, ung- og smábarnavernd,
foreldrar, heilsugæsla.Aim: Postnatal home visits from nurses in well-childcare aim to
provide parental support and education, at a sensitive time. The
purpose of this study was to examine parents’ experience with
home visits by nurses from public healthcare centers. Also, to assess if there was a difference in the views of first-time parents and
those who have had a child before.
Method: Descriptive cross-sectional study. The sample consists of
parents who brought children in for six and nine weeks appointments at the healthcare centers in the capital area in Iceland, early
in 2020. Parents who agreed to participate were sent an electronic
questionnaire with 27 open and closed questions, 19 questions
about home visits and 8 about their background.
Results: During the study period 390 children came for six or nine
weeks appointments at the healthcare centers. Parents of 136 children participated (35%). Most of them (93%) were female and just
under half were having their first child (49%). Most participants
(92%) were satisfied with home visits and appreciated the counseling and education provided by the nurses. Most found the home
visits to be appropriately frequent (84%) and reasonably long
(96%). Small part of participants (8,1%) was dissatisfied with
home visit from a nurse. First-time parents were significantly more
dissatisfied with counseling and education than those who had a
child before. No significant difference was between the attitudes
of first-time parents and those who had a child before, regarding
the frequency or duration of visits.
Conclusion: The results of this study strongly indicate that home
visits from nurses in well-childcare are important to parents. Most
participants were pleased with the home visits by nurses. First time
parents need better support because they were significantly more
dissatisfied with counseling and education than those who had a
child before.
Keywords: nurses, home visits,well-childcare, parents, primary car
A European Research Agenda for Geriatric Emergency Medicine: a modified Delphi 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 DownloadPurpose: Geriatric Emergency Medicine (GEM) focuses on delivering optimal care to (sub)acutely ill older people. This involves a multidisciplinary approach throughout the whole healthcare chain. However, the underpinning evidence base is weak and it is unclear which research questions have the highest priority. The aim of this study was to provide an inventory and prioritisation of research questions among GEM professionals throughout Europe.
Methods: A two-stage modified Delphi approach was used. In stage 1, an online survey was administered to various professionals working in GEM both in the Emergency Department (ED) and other healthcare settings throughout Europe to make an inventory of potential research questions. In the processing phase, research questions were screened, categorised, and validated by an expert panel. Subsequently, in stage 2, remaining research questions were ranked based on relevance using a second online survey administered to the same target population, to identify the top 10 prioritised research questions.
Results: In response to the first survey, 145 respondents submitted 233 potential research questions. A total of 61 research questions were included in the second stage, which was completed by 176 respondents. The question with the highest priority was: Is implementation of elements of CGA (comprehensive geriatric assessment), such as screening for frailty and geriatric interventions, effective in improving outcomes for older patients in the ED?
Conclusion: This study presents a top 10 of high-priority research questions for a European Research Agenda for Geriatric Emergency Medicine. The list of research questions may serve as guidance for researchers, policymakers and funding bodies in prioritising future research projects.
Keywords: Geriatric Emergency Medicine; Research prioritisation.Dutch Ministry of Health and Welfare
Netherlands Organization for Health Research and Development
FW
Clinical spectrum of coronavirus disease 2019 in Iceland: population based cohort 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: To characterise the symptoms of coronavirus disease 2019 (covid-19).
Design: Population based cohort study.
Setting: Iceland.
Participants: All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery.
Main outcome measures: Occurrence of one or more of 19 predefined symptoms during follow-up.
Results: Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease.
Conclusion: In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis
The prevalence of psychiatric diagnoses and psychotropic medication in icelandic nursing homes from 2003 to 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 DownloadINNGANGUR
Faraldsfræðilegar rannsóknir sýna mikla útbreiðslu geðræns vanda og
geðlyfjanotkunar meðal aldraðra í þróuðum löndum, ekki síst meðal
þeirra sem búa á hjúkrunarheimilum. Þekkingu á geðrænum vanda
og geðlyfjanotkun íbúa íslenskra hjúkrunarheimila er ábótavant, en
mikilvæg fyrir stefnumótun í geðheilbrigðisþjónustu á heimilunum. Því
var tilgangur rannsóknarinnar að kanna algengi geðsjúkdómsgreininga
og geðlyfjanotkunar meðal íbúa íslenskra hjúkrunarheimila, samspil
þessara þátta og hvernig þeir hafa þróast frá 2003 til 2018.
EFNIVIÐUR OG AÐFERÐIR
Rannsóknargögnin voru fengin úr niðurstöðum matsgerða með annarri
útgáfu interRAI mælitækisins á tímabilinu frá 2003 til 2018. Í rannsókninni var stuðst við síðasta mat hvers árs (N=47,526).
NIÐURSTÖÐUR
Á tímabilinu hafði um það bil helmingur íbúanna kvíða- og/eða
þunglyndisgreiningu; 49,4% árið 2003, en 54,5% 2018. Þessi tíðni jókst
til ársins 2010 er hún var 60,9%. Hún hefur síðan farið hægt minnkandi.
Neysla geðlyfja jókst úr 66,3% í 72,5%. þunglyndislyf eru algengust og
jókst neysla þeirra úr 47,5% í 56,2. Neysla geðrofslyfja hefur haldist nær
óbreytt, eða í kringum 26%. Nokkurt ósamræmi var á milli geðsjúkdómagreininga og geðlyfjanotkunar. Þannig fengu að meðaltali 18,2%
geðlyf að staðaldri án þess að hafa greiningu og 22,3% tóku geðrofslyf í
öðrum tilfellum en mælt er með.
ÁLYKTANIR
Aldursbreytingar hafa áhrif á verkun geðlyfja og rannsóknir hafa ekki
staðfest jákvæða langtímaverkun þeirra fyrir aldraða. Þeir eru einnig
viðkvæmir fyrir skaðlegum aukaverkunum lyfjanna sem aukast enn
með fjöllyfjanotkun. Því er mikilvægt að geðlyfjanotkun aldraðra sé
byggð á nákvæmri geðskoðun. Eins er mikilvægt að þróa önnur úrræði
til að efla geðheilsu íbúa íslenskra hjúkrunarheimila.INTRODUCTION: Research shows a high prevalence of mental disorders and psychotropic
medication among older people, especially in nursing homes. Knowledge of this concerning
issue among Icelandic nursing homes residents is limited, despite its importance for mental
health policymaking. Therefore, the aim of this study was to investigate the prevalence of
psychiatric diagnoses and psychotropic medication in Icelandic nursing homes, the relationship
between these factors and how they have evolved from 2003 to 2018.
MATERIAL AND METHODS: The research data comes from interRAI MDS 2.0 assessments for
nursing home residents in Iceland, for the period 2003-2018. The study uses the last assessment
of each year (N=47,526).
RESULTS: Approximately half of the residents were diagnosed with anxiety and/or depression;
49.4% in 2003 and 54.5% in 2018. The use of psychotropic drugs increased from 66.3% to 72.5%.
Antidepressants were most commonly utilized, with an increase from 47.5% to 56.2%. The use of
antipsychotics drugs has remained nearly unchanged, at around 26%. Inconsistency was found
between psychotropic medication and psychiatric diagnoses; on average, 18.2% of the residents
took psychotropic drugs without being diagnosed and 22.3% took antipsychotics in other cases
than recommended.
CONCLUSION: Age related changes influence the effect of psychotropic drugs and studies
have not supported their positive long-term effects for older people who are also sensitive to
associated adverse effects, especially in cases of polypharmacy. Therefore, it is important that
psychotropic drugs use is based on accurate mental health assessment. To reduce psychotropic
medication, other mental health interventions need to be developed.Vísindasjóður Landspítala og Vísindasjóður Félags íslenskra hjúkrunarfræðinga
Decrement Evoked Potential Mapping to Guide Ventricular Tachycardia Ablation: Elucidating the Functional Substrate.
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 DownloadEmpirical approaches to targeting the ventricular tachycardia (VT) substrate include mapping of late potentials, local abnormal electrogram, pace-mapping and homogenisation of the abnormal signals. These approaches do not try to differentiate between the passive or active role of local signals as the critical components of the VT circuit. By not considering the functional components, these approaches often view the substrate as a fixed anatomical barrier. Strategies to improve the success of VT ablation need to include the identification of critical functional substrate. Decrement-evoked potential (DeEP) mapping has been developed to elucidate this using an extra-stimulus added to a pacing drive train. With knowledge translation in mind, the authors detail the evolution of the DeEP concept by way of a study of simultaneous panoramic endocardial mapping in VT ablation; an in silico modelling study to demonstrate the factors influencing DeEPs; a multicentre VT ablation validation study; a practical approach to DeEP mapping; the potential utility of DeEPs to identify arrhythmogenic atrial substrate; and, finally, other functional mapping strategies
Diseases connected with work in hay in Iceland. Haymaking and old data on such diseases
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 DownloadHeysjúkdómar hafa vafalaust fylgt búskaparháttum Íslendinga alveg
frá landnámi í lok 9. aldar. Þó hafa aðstæður til heyöflunar verið betri á
fyrstu öldum eftir landnám en seinna varð, þegar veðurfar kólnaði og
landgæði versnuðu. Greinin fjallar um það sem skrifað hefur verið um
heysjúkdóma á Íslandi frá byrjun 17. aldar og fram á miðja 20. öldina.Diseases connected with work in hay have existed in Iceland since its settlement
late in the 9th century. Haymaking was probably easier in those days because of
better climate and land quality but became more difficult later when these factors
deteriorated. First data on diseases connected with hay are from the early 17th century where the word „haysickness“ (in Icelandic „heysótt“) is used in a book on treatment of diseases. Later in the century the word is found in a rhyme that says „short
of breath due to haysickness“. The word „haysickness“ is also found in dictionaries
from that time. In a book from 1730-40 says: „Haysickness sometimes causes illness and loss of appetite in those that loosen hay in a compressed haystack with a
hayneedle or a hook.“ At the end of the 18th century Jón Pétursson writes a good description of hay diseases: „It cannot be denied that haysickness not taken seriously
or long ignored can cause many deaths in this country.“ Jón Finsen mentions in his
doctoral thesis in 1874 that the symptoms of haysickness are different from those of
allergy to pollen (hay fever) that had been recently described.
In 1870 the Director of Health writes directions for farmers on how to reduce the
danger of getting haysickness by using a thin cloth facemask when loosing hay from
a haystack
Respiratory movement, lung volumes and respiratory muscle strength following lung transplantation. Pilot study with 4 recipients
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 DownloadBakgrunnur. Við lungnaígræðslu er algengast að skorið sé þvert
á bringubein og á báða millirifjavöðva beggja vegna frá
bringubeini aftur að hryggsúlu. Rifbeinin fyrir ofan og neðan
skurðinn eru spennt í sundur til að fá aðgang að lungunum. Við
það verða áverkar á liðamótum aðliggjandi rifja og á þind sem
gæti valdið óskilvirkri öndun. Markmið. Að gera forrannsókn á
valtilgátunni: Lungnaþegar eru með skert lungnarúmmál, skertar
öndunarhreyfingar og skertan styrk öndunarvöðva þrátt fyrir
ígrædd heilbrigð lungu. Siðanefnd heilbrigðisrannsókna á
Landspítala samþykkti rannsóknina (39/2016) og hún var tilkynnt
Persónuvernd. Aðferðir. Þátttakendur voru fjórir lungnaþegar,
þrjár konur og einn karl á aldrinum 40-62 ára, BMI 22 - 40, sem
undirrituðu upplýst samþykki fyrir þátttöku. Mæld voru:
Lungnarúmmál, öndunarhreyfingar, styrkur öndunarvöðva,
hámarks innöndunarþrýstingur og hámarks útöndunarþrýstingur.
Niðurstöður. Ástæða lungnaígræðslu var langvinn lungnateppa
hjá einum, hjá hinum þremur lungnatrefjun, konurnar fengu bæði
Öndunarhreyfingar, lungnarúmmál
og styrkur öndunarvöðva eftir
lungnaígræðslu. Forrannsókn
með fjórum lungnaþegum
Höfundar: Guðbjörg Þóra Andrésdóttir1, Sara Hafsteinsdóttir1 og dr. María Ragnarsdóttir2
Vinnustaður: 1Sjúkraþjálfun Landspítala Háskólasjúkrahúsi, Fossvogi
2Fyrrum starfandi í Sjúkraþjálfun Hringbraut, Landspítala Háskólasjúkrahúsi,
nú sjálfstætt starfandi
G. Þóra An d r é s d ót t i r
Sérfræðingur í taugasjúkraþjál fun
L an d s p í tala Fo s s v ogi
Mar í a R agnar d ót t i r
Sj ú k ra þ j á l far i P hD
Fyrrum rannsóknasjúkraþjálfari LSH
S ara Ha f s t e i n s d ót t i r
Yf i r s j ú k ra þ j á l far i
L an d s p í tala Fo s s v ogi
Sjúkraþjálfarinn 43
Ritrýnd grein
lungu ígrædd en karlinn vinstra lunga. Öll voru með
hámarksfráblástur á einni sekúndu (FEV1) undir 80%, en
mismikið og skertar lágrifja hreyfingar í hvíld, þrjú í djúpri öndun
og sömu þrjú voru með skertan styrk í innöndunarvöðvum.
Ályktanir. Niðurstöður forrannsóknar benda til að vert sé að
kanna tilgátuna í stærri rannsókn þar sem mælt yrði fyrir og eftir
ígræðslu. Ef til vill er nú þegar rétt að mæla með viðameiri skoðun
og meðferð á öndunarmynstri og styrk öndunarvöðva hjá
lungnaþegum en nú er gert. Það gæti leitt til skilvirkari starfsemi
öndunarvöðva sem tækju til sín minna hlutfall
heildarsúrefnisupptöku líkamans og skildi meira eftir fyrir aðra
líkamsstarfssemi en að anda.Background. The surgical procedure of lung transplant involves
transverse cross section of sternum and the intercostal muscles
from sternum to the vertebra. The adjacent ribs are forced apart in
order to get access to the lungs. This is likely to cause injury to
costovertebral joints and diaphragm which could cause ineffective
breathing. Purpose. To pilot test our alternative hypothesis that
transplant recipients have decreased lung volumes, decreased
respiratory movement and decreased respiratory muscle strength
despite normal lungs. The study was approved by the Medical
Research Ethical Committee (39/2016) and reported to The
Icelandic Data Protection Authority. Method. Participants, four
lung transplant recipients, three women and one man aged 40- 62
years, BMI 22-40, signed informed consent prior to participation.
Measurements: Lung volumes, respiratory movement and
respiratory muscle strength, maximal inspiratory pressure (MIP)
and maximal expiratory pressure (MEP). Results. One had
chronic obstructive pulmonary disease and three had pulmonary
fibrosis prior to transplantation, the women had double lung
transplant but the man had left lung transplant. All four had FEV1
below 80% of predicted and decreased lower thoracic respiratory
movement during quiet breathing, three during voluntary deep
breathing and the same three had decreased inspiratory muscle
strength. Conclusions. The results of this pilot study indicate that
it would be worthwhile to test the hypothesis in a clinical trial and
measure before and after transplantation. It is even appropriate to
recommend more comprehensive assessment and treatment of
respiratory movement pattern and respiratory muscle strength
than is routinely done at present. It could lead to more efficient
respiratory muscles using less percentage of the total oxygen
consumption leaving more for other body functions than breathing