Landspítali University Hospital Research Archive
Not a member yet
7973 research outputs found
Sort by
Mild Stage 1 post-operative acute kidney injury: association with chronic kidney disease and long-term survival.
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 DownloadPre- and post-operative SCr values were available for 47 333 (42%) surgeries. Of those, 1161 (2.4%) had mild Stage 1 AKI and 2355 (5%) more severe forms of AKI. Mild Stage 1 AKI was associated with both incident CKD and progression of pre-existing CKD (P < 0.001). After exclusion of post-operative deaths within 30 days, mild Stage 1 AKI was not associated with worse 1-year survival in patients with preserved kidney function (94% versus 94%, P = 0.660), and same was true for patients with pre-operative CKD (83% versus 82%, P = 0.870) compared with their matched individuals. Conclusions. Mild Stage 1 AKI is associated with development and progression of CKD, but not with inferior 1-year survival. These findings support the inclusion of a small absolute increase in SCr in the definition of AKI.Landspitali University Hospital Research Fun
Fetal descent in nulliparous women assessed by ultrasound: a longitudinal study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Ultrasound measurements offer objective and reproducible methods to measure the fetal head station. Before these methods can be applied to assess labor progression, the fetal head descent needs to be evaluated longitudinally in well-defined populations and compared with the existing data derived from clinical examinations.
Objective: This study aimed to use ultrasound measurements to describe the fetal head descent longitudinally as labor progressed through the active phase in nulliparous women with spontaneous onset of labor.
Study design: This was a single center, prospective cohort study at the Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland, from January 2016 to April 2018. Nulliparous women with a single fetus in cephalic presentation and spontaneous labor onset at a gestational age of ≥37 weeks, were eligible. Participant inclusion occurred during admission for women with an established active phase of labor or at the start of the active phase for women admitted during the latent phase. The active phase was defined as an effaced cervix dilated to at least 4 cm in women with regular contractions. According to the clinical protocol, vaginal examinations were done at entry and subsequently throughout labor, paired each time with a transperineal ultrasound examination by a separate examiner, with both examiners being blinded to the other's results. The measurements used to assess the fetal head station were the head-perineum distance and angle of progression. Cervical dilatation was examined clinically.
Results: The study population comprised 99 women. The labor patterns for the head-perineum distance, angle of progression, and cervical dilatation differentiated the participants into 75 with spontaneous deliveries, 16 with instrumental vaginal deliveries, and 8 cesarean deliveries. At the inclusion stage, the cervix was dilated 4 cm in 26 of the women, 5 cm in 30 of the women, and ≥6 cm in 43 women. One cesarean and 1 ventouse delivery were performed for fetal distress, whereas the remaining cesarean deliveries were conducted because of a failure to progress. The total number of examinations conducted throughout the study was 345, with an average of 3.6 per woman. The ultrasound-measured fetal head station both at the first and last examination were associated with the delivery mode and remaining time of labor. In spontaneous deliveries, rapid head descent started around 4 hours before birth, the descent being more gradual in instrumental deliveries and absent in cesarean deliveries. A head-perineum distance of 30 mm and angle of progression of 125° separately predicted delivery within 3.0 hours (95% confidence interval, 2.5-3.8 hours and 2.4-3.7 hours, respectively) in women delivering vaginally. Although the head-perineum distance and angle of progression are independent methods, both methods gave similar mirror image patterns. The fetal head station at the first examination was highest for the fetuses in occiput posterior position, but the pattern of rapid descent was similar for all initial positions in spontaneously delivering women. Oxytocin augmentation was used in 41% of women; in these labors a slower descent was noted. Descent was only slightly slower in the 62% of women who received epidural analgesia. A nonlinear relationship was observed between the fetal head station and dilatation.
Conclusion: We have established the ultrasound-measured descent patterns for nulliparous women in spontaneous labor. The patterns resemble previously published patterns based on clinical vaginal examinations. The ultrasound-measured fetal head station was associated with the delivery mode and remaining time of labor.
Keywords: angle of progression; cesarean delivery; fetal head position; fetal head station; head-perineum distance; transabdominal ultrasound; transperineal ultrasound.Icelandic Centre for Researc
Medical records at the National Hospital of Iceland: Present status and future prospects
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
Markmið rannsóknarinnar var að kanna hvernig staðið væri að
sjúkraskrármálum á Landspítala og skoða stefnumótun varðandi þessi
mál meðal stjórnenda og starfsfólks. Rannsókn sem þessi hefur ekki
áður verið gerð. Hún leggur til nýja þekkingu varðandi kerfisbundna
skjalastjórn sjúkraskráa og fræðilegt gildi hennar felst í að kanna hvernig
staðið er að viðkvæmum málaflokki út frá lagalegum sjónarmiðum og
upplýsingaöryggi. Hagnýtt gildi rannsóknarinnar felst í því að hægt er
að nýta niðurstöðurnar sem stöðumat á yfirstandandi verkefnum og
áætlunum innan Landspítala.
EFNIVIÐUR
Beitt var eigindlegri aðferðafræði við gagnaöflun og greiningu og
stuðst við margprófun og grundaða kenningu. Fyrirliggjandi rituð gögn
voru skoðuð, viðtöl tekin, þátttökuathuganir framkvæmdar og loks var
rýnihópur settur saman. Þó að ekki sé hægt að alhæfa um niðurstöðurnar
gefa þær mikilvægar vísbendingar um ástand mála, ekki síst þar sem
mettun virtist hafa náðst og ekki líklegt að viðbótargagnasöfnun hefði
bætt við nýjum upplýsingum.
NIÐURSTÖÐUR
Rannsóknarniðurstöður sýna að unnið hefur verið ötullega að mótun
og innleiðingu á upplýsingastefnu og aðgengisstefnu í samræmi við
lög, reglur og alþjóðlega staðla og ljóst er að stjórnendur hafa sett sér
háleit markmið. Þá hefur alþjóðleg vottun fengist innan heilbrigðis- og
upplýsingatæknideildar varðandi upplýsingaöryggi.
ÁLYKTUN
Meginvandinn virðist vera tvíþættur: Í fyrsta lagi þyrfti yfirstjórn
málaflokksins innan spítalans að vera skýrari og í öðru lagi hefur
ekki tekist að afla nauðsynlegs fjár þannig að hægt sé að framfylgja
markmiðum á árangursríkan hátt. Í ljós kom að skerpa þarf á stuðningi
stjórnenda, bæta fræðslumálin til muna og efla öryggisvitund og ábyrgð
starfsfólks í tengslum við sjúkraskrár.INTRODUCTION: The aim of the research was to examine the status of medical records at
the National Hospital in Iceland. The aim was, furthermore, to examine the policy making
regarding records among managers and other employees. A research such as this has
not been undertaken previously. It provides new knowledge regarding the systematic
management of medical records. The academic value of the research is the discovery of
how sensitive records are being managed from a legal standpoint as well as information
security. The practical value of the research is that its findings can be used as a status
evaluation of ongoing assignments and plans within the National Hospital.
SUBSTANCE: Qualitative research methods were used for the collection and analysis of
the data supported by triangulation and grounded theory. Available written material was
examined, interviews were conducted, and participant observations took place. Finally, a
focus group was formed. Although the conclusions cannot be generalized, they do provide
important indications regarding the state of records management, as a level of saturation
was reached in the data collection, and it was deemed unlikely that additional data would
have added information of significant value.
RESULTS: The findings of the research show that important work has been undertaken to
form and implement a policy regarding information and access to records in accordance
with law, regulations and international standards. It is obvious that the managers have
set themselves ambitious goals in this respect. Moreover, an international certification
has been obtained within the health and information technology department regarding
information security.
CONCLUSIONS: The main problem seems to be twofold: First, a clarification of the
administration and responsibility of health records is needed, and second that the hospital
has not succeeded in securing enough funds in order to pursue established policies in an
effective manner. It was revealed that top management support needs to be strengthened;
training and education need improvement and the awareness of hospital staff of their
responsibility regarding the security of medical records must be emphasized
,,It overtook my body and soul“: The experience of individuals receiving health-promoting service, of psychological trauma and health-related problems
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
Rannsóknir sýna að einstaklingar sem hafa orðið fyrir sálrænum
áföllum glíma oft við fjölþætt heilsufarsvandamál. Heilsueflandi
móttaka heilsugæslu beinist að skjólstæðingum sem glíma við slík
heilsufarsvandamál þar sem veitt er einstaklingsmiðuð meðferð og
stuðningur. Áfallamiðuð nálgun er mikilvæg í heilbrigðisþjónustu og getur
eflt lífsgæði einstaklinga eftir sálræn áföll.
Tilgangur rannsóknar var að skoða reynslu einstaklinga í heilsueflandi
móttöku heilsugæslu af sálrænum áföllum og heilsufarsvandamálum.
AÐFERÐ
Eigindleg viðtalsrannsókn þar sem stuðst var við Vancouver-skólann í
fyrirbærafræði. Þátttakendur voru 5 karlmenn og 5 konur, valin í gegnum
heilsueflandi móttöku heilsugæslu. Viðtöl við hvern þátttakanda voru tvö.
Stuðst var við ACE-spurningalistann sem skimunartæki fyrir sálrænum
áföllum í bernsku ásamt viðtalsramma rannsakenda, með opnum
spurningum.
NIÐURSTÖÐUR
Niðurstöður voru greindar í 6 meginþemu: Upplifun af áföllum, Endurtekin
áföll, Vanræksla í æsku, Líkamleg heilsufarsvandamál í æsku og á
fullorðinsárum, Geðræn heilsufarsvandamál í æsku og á fullorðinsárum,
Úrvinnsla og áfallamiðuð nálgun. Þátttakendur höfðu flestir orðið fyrir
fjölþættum sálrænum áföllum og flóknum heilsufarsvandamálum, bæði
í æsku og á fullorðinsárum. Rauði þráður rannsóknarinnar: ,,Það dundi
yfir líkama og sál“ endurspeglar reynslu þátttakenda af áföllum og
heilsufarsvandamálum.
ÁLYKTANIR
Mikilvægt er að heilbrigðisstarfsfólk taki mið af sálrænum áföllum þegar
hugað er að heilsufarsvandamálum skjólstæðinga, geti veitt stuðning
og viðeigandi aðstoð. Heilsugæslan er oftast fyrsti viðkomustaður
skjólstæðinga í heilbrigðiskerfinu og því mikilvægt að þar sé innleidd
áfallamiðuð nálgun. Innan heilsueflandi móttöku heilsugæslu er mikilvægt
að kortleggja heilsufarsvandamál í tengslum við sálræn áföll og þar er
tækifæri til að efla áfallamiðaða nálgun.INTRODUCTION: Accumulating evidence shows that those having experienced psychological
trauma have increased risk of complex health problems. In primary health care healthpromoting services are offered to individuals with complex health problems, based on an
individualized approach. Trauma focused approach in healthcare help individuals increase
quality of life after psychological trauma. Trauma focused services are important to help
improve quality of life after psychological trauma.
To examine the experience of psychological trauma and health-related problems in individuals
receiving health-promoting services.
METHOD: Qualitative research based on the Vancouver School of phenomenology. Participants
were ten, five male and five female, selected through health-promoting services. Two
interviews were taken with each participant. The ACE questionnaire was used, as a screening
tool for childhood psychological trauma, combined with interview-frame with open questions.
RESULTS: The results were divided into six main themes: Experience of trauma; Repeated
trauma; Childhood neglect; Health-related problems in child- and adulthood; Psychiatric
problems in child- and adulthood; Processing and trauma-focused approach. Participants had
experienced conciderable trauma as well as complex health problems in child- and adulthood.
CONCLUSIONS: It is of importance that healthcare professionals pay attention to psychological
traumas in relation to complex health problems to provide support for recovery. Primary health
care is the first place of contact within the health care system and therefore it is important that
patients‘ experience of trauma is taken into account. It is key to identify the signs of lifetime
trauma in relation to health problems and focus the care according to the individual needs of
the patient.Heilsugæsla höfuðborgarsvæðisins og Félag íslenskra
hjúkrunarfræðing
Ákveðin forréttindi að vera handleiðari
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 Downloa
Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR).
Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM).
Results: From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study.
Conclusion: Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
Keywords: #Kidney Cancer; #kcsm; #uroonc; RECUR; follow up; guidelines; partial nephrectomy; radical nephrectomy; renal cell carcinoma; survival
Paracetamol poisoning: a population-based study from Iceland.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: To examine the incidence and severity of paracetamol poisoning in a population-based cohort in Iceland. A previous study showed a decrease in the incidence during a financial crisis in Iceland, by approximately half (16/100,000 annually). The aims of the study were to assess the incidence and nature of paracetamol poisoning after economic recovery in Iceland and to compare intentional and accidental poisoning.
Methods: Paracetamol serum concentrations were used to identify patients in this retrospective study from 2010-2017. A search was undertaken in laboratory databases for patients with serum paracetamol concentrations, which were grouped by <66 µmol/L (below detection limit) and ≥66 µmol/L. Medical records were reviewed and relevant laboratory and clinical information obtained to determine whether paracetamol poisoning had occurred.
Results: Altogether 542 cases of paracetamol poisoning were identified. The mean annual incidence was 27/100,000 (range 22-33). Intentional poisoning was observed in 437/542 (81%) cases, most frequently among females 16-25 years of age. Males ≥65 years were more likely to overdose by accident, which was associated with worse outcomes. Twenty-five (4.6%) patients developed severe paracetamol-induced liver injury and coagulopathy. Overall, six (1.1%) cases were fatal in which paracetamol contributed to the cause of death, with accidental poisoning found in 67% (4/6).
Conclusions: The incidence of paracetamol poisoning has increased in recent years associated with economic recovery in Iceland. Most patients had favourable outcomes. Intentional overdose was most common in young females, whereas accidental overdose was more common in older males and more frequently associated with a fatal outcome.
Keywords: Accidental; acute liver failure; epidemiology; incidence; intentional; liver injury; overdose; paracetamol (acetaminophen); poisoning
Validation of the Hospital Frailty Risk Score in older surgical patients: A population-based retrospective cohort study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: There is a need for standardized and cost-effective identification of frailty risk. The objective was to validate the Hospital Frailty Risk Score which utilizes International Classification Diagnoses in a cohort of older surgical patients, assess the score as an independent risk factor for adverse outcomes and compare discrimination properties of the frailty risk score with other risk stratification scores.
Methods: Data were analysed from all patients ≥65 years undergoing primary surgical procedures from 2006-2018. Patients were categorized based on the frailty risk score. The primary outcomes were 30-day mortality and 180-day risk of readmission.
Results: Of 16 793 patients evaluated, 7480 (45%), 7605 (45%) and 1708 (10%) had a low, intermediate and high risk of frailty. There was a higher incidence of 30-day mortality for individuals with intermediate (2.9%) and high (8.3%) compared with low (1.4%) risk of frailty (P < .001 for both comparisons). Similarly, the hazard of readmission within the first 180 days was higher for intermediate (HR 1.25; 95% CI: 1.16-1.34) and high (HR 1.84; 95% CI: 1.66-2.03) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. The hazard of long-term mortality was higher for intermediate (HR 1.70; 95% CI: 1.61-1.80) and high (HR 4.16; 95% CI: 3.84-4.49) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. Finally, long length of primary hospitalization occurred for 9.3%, 15.0% and 27.3% of individuals with low, intermediate and high frailty risk (P < .001 for all comparisons). A model including age and ASA classification had the best discrimination for 30-day mortality (AUC 0.862; 95% CI: 0.847-0.877).
Conclusion: Our findings suggest that the Hospital Frailty Risk Score might be used to screen older surgical patients for risk of frailty. While only slightly improving prediction of 30-day mortality using the ASA classification, the Hospital Frailty Risk Score can be used to independently classify older patients for the risk of important outcomes using pre-existing readily available electronic data
Computed tomography-based skeletal muscle and adipose tissue attenuation: Variations by age, sex, and muscle.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: This study aimed to investigate how skeletal muscle attenuation and adipose tissue (AT) attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle vary according to the targeted muscles, sex, and age.
Design: Population-based cross-sectional study.
Setting: Community-dwelling old population in Reykjavik, Iceland.
Subjects: A total of 5331 older adults (42.8% women), aged 66-96 years from the Age, Gene/Environment Susceptibility (AGES)- Reykjavik Study, who participated in the baseline visit (between 2002 and 2006) and had valid thigh and abdominal computed tomography (CT) scans were studied.
Methods: Muscle attenuation and AT attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle were determined using CT. Linear mixed model analysis of variance was performed for each sex, with skeletal muscle or AT attenuation as the dependent variable.
Results: Muscle attenuation decreased, and AT attenuation increased with age in both sexes, and these differences were specific for each muscle, although not in all age groups. Age-related differences in muscle and AT attenuation varied with specific muscle. In general, for both sexes, skeletal muscle attenuation of the hamstrings declined more than average with age. Men and women displayed a different pattern in the age differences in AT attenuation for each muscle.
Conclusions: Our data support the hypotheses that skeletal muscle attenuation decreases, and AT attenuation increases with aging. In addition, our data add new evidence, supporting that age-related differences in skeletal muscle and AT attenuation vary between muscles.
Keywords: Computed tomography; Fat; Thigh muscles; Tissue density; Trunk muscles.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute on Aging (NIA)
Hjartavernd (the Icelandic Heart Association)
Althingi (the Icelandic Parliament
Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe.
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 DownloadIn 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.Ministry of Health, Welfare and Sport, the Netherlands as part of the EV surveillance program of the National Institute for Public Health and the Environment
European Union Horizon 2020 research and innovation program (COMPARE grant from Aristotle University of Thessaloniki, Greece)
Wellcome Trust
European Commission
Belgian National Reference Center for Enteroviruses from the RIZIV/INAMI (National Institute for Health and Disability Insurance)
HONOURs Horizon 2020 Marie Sklodowska-Curie Training Networ