Landspítali University Hospital Research Archive
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Predictive variables for poor long-term physical recovery after intensive care unit stay: An exploratory study.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Elucidating factors that influence physical recovery of survivors after an intensive care unit (ICU) stay is paramount in maximizing long-term functional outcomes. We examined potential predictors for poor long-term physical recovery in ICU survivors.
Methods: Based on secondary analysis of a trial of 50 ICU patients who underwent mobilization in the ICU and were followed for one year, linear regression analysis examined the associations of exposure variables (baseline characteristics, severity of illness variables, ICU-related variables, and lengths of ICU and hospital stay), with physical recovery variables (muscle strength, exercise capacity, and self-reported physical function), measured one year after ICU discharge.
Results: When the data were adjusted for age, female gender was associated with reduced muscle strength (P = .003), exercise capacity (P < .0001), and self-reported physical function (P = .01). Older age, when adjusted for gender, was associated with reduced exercise capacity (P < .001). After adjusting for gender and age, an association was observed between a lower score on one or two physical recovery variables and exposure variables, specifically, high body mass index, low functional independence, comorbidity and low self-reported physical function at baseline, muscle weakness at ICU discharge, and longer hospital stay. No adjustment was made for cumulative type I error rate due to small number of participants.
Conclusion: Elucidating risk factors for poor long-term physical recovery after ICU stay, including gender, may be critical if mobilization and exercise are to be prescribed expediently during and after ICU stay, to ensure maximal long-term recovery.Landspitali - The National University Hospital of Iceland Research Fund in 2011-2013
Icelandic Physiotherapy Association Research Fund in 2016
University of Iceland Teachers Assistant Fund for PhD students in 2016-1
Impact of technology-based patient education on modifiable cardiovascular risk factors of people with coronary heart disease: A systematic review.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: To collect evidence on what types of technology and content are most effective in helping people with coronary heart disease (CHD) to change their modifiable cardiovascular risk factors.
Methods: A literature search was performed to find relevant studies published between 1 January 2008 and 31 December 2018 in PubMed, CINAHL, PROQUEST and Scopus databases. Selected outcomes were risk factors (exercise, diet, blood pressure, blood sugar, cholesterol, body mass index, tobacco use). The quality of the studies was evaluated according to Joanna Briggs Institute Reviewers Manual Checklists for risk for bias, TIDieR for quality of interventions, and PRISMA statement for presenting results.
Results: Eighteen quantitative (17 RCT´s and one quasi-experimental) studies were included. Patient education delivered through telephone, text messaging, webpages, and smartphone applications resulted in significant changes in some risk factors of people with CHD. Sufficient descriptions of the content and intervention methods were lacking.
Conclusion: Patient education delivered with technology can help people with CHD to modify their risk factors. There is a need for better descriptions of the content and delivery of educational interventions in studies.
Practice implications: Patient education needs to be delivered with technological solutions that best support the multidimensional needs of CHD patients.
Keywords: Cardiac rehabilitation; Coronary heart disease; Lifestyle changes; Patient education; Risk factors; Secondary prevention; Telehealth; e-health
Towards an app to estimate patient-specific perioperative femur fracture risk
Get PDFTo access publisher's full text version of this article click on the hyperlink belowTotal Hip Arthroplasty is one of the most successful surgery. However, due to the worldwide growing population life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on medical operators’ expertise and qualitative information obtained by imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between actual strength distribution inside the bone tissue and its response to the forces exerted by the implant. To this end, we produce charts and patient-specific synthetic “traffic-light” indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of CT-based mechanical and geometrical parameters of the patient. We felt that, if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implantUniversita degli Studi della Campania "L.Vanvitelli", grant Programma VALERE: "VAnviteLli pEr la RicErca", DD
Improving Prosthetic Selection and Predicting BMD from Biometric Measurements in Patients Receiving Total Hip Arthroplasty.
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 DownloadThere are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis; the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients.
Keywords: clinical decision making; database analyses; electromyography; machine learning; total hip arthroplasty.University of Reykjavik
Icelandic National Hospital
Rannis (Rannis Icelandic Research Fund (Rannsoknasjodur))
A&C M-C Foundation of Translational Myology, Padova, Ital
A comparison of platelet quality between platelets from healthy donors and hereditary hemochromatosis donors over seven-day storage.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Therapeutic phlebotomy is the standard treatment of hereditary hemochromatosis (HH), the most common genetic disease in people of Northern European descent. Red cell concentrates from HH donors have been reported safe for transfusion, but little data is available on the storage properties of platelet concentrates from HH donors.
Study design and methods: Whole blood was collected from 10 healthy individuals and 10 newly diagnosed HH patients with elevated serum ferritin. Platelet-rich plasma (PRP) was prepared and split into four 20-mL units. Platelet quality tests were performed on days 0, 1, 3, 5, and 7 of storage, including platelet aggregation (ADP, arachidonic acid, collagen, and epinephrine agonists), blood gas analysis, flow cytometry (CD41, CD42b, and CD62P expression), and ELISA (sCD40L and sCD62p in supernatant).
Results: Mean serum ferritin levels were higher in HH patients than in controls (847.5 vs 45.8 ng/mL, P .05), including blood gas analysis, platelet aggregation, and expression of surface (CD62p and CD42b) and secreted (sCD62P and sCD40L) activation markers. Expected alterations in metabolic (CO2 and glucose decrease, O2 and lactate increase, P < .001) and platelet activation markers (CD42b decrease, CD62P increase, P < .05) over time were observed in both groups.
Conclusion: Although these findings indicate that platelets of individuals with HH are comparable to platelets from healthy donors, more extensive studies are needed before definite conclusions can be drawn.Landspitali National University Hospital Research Fun
Mendelian disorders of the epigenetic machinery: postnatal malleability and therapeutic prospects.
No full textTo access publisher's full text version of this article click on the hyperlink belowhe epigenetic machinery in conjunction with the transcriptional machinery is responsible for maintaining genome-wide chromatin states and dynamically regulating gene expression. Mendelian disorders of the epigenetic machinery (MDEMs) are genetic disorders resulting from mutations in components of the epigenetic apparatus. Though individually rare, MDEMs have emerged as a collectively common etiology for intellectual disability (ID) and growth disruption. Studies in model organisms and humans have demonstrated dosage sensitivity of this gene group with haploinsufficiency as a predominant disease mechanism. The epigenetic machinery consists of three enzymatic components (writers, erasers and chromatin remodelers) as well as one non-enzymatic group (readers). A tally of the entire census of such factors revealed that although multiple enzymatic activities never coexist within a single component, individual enzymatic activities often coexist with a reader domain. This group of disorders disrupts both the chromatin and transcription states of target genes downstream of the given component but also DNA methylation on a global scale. Elucidation of these global epigenetic changes may inform our understanding of disease pathogenesis and have diagnostic utility. Moreover, many therapies targeting epigenetic marks already exist, and some have proven successful in treating cancer. This, along with the recent observation that neurological dysfunction in these disorders may in fact be treatable in postnatal life, suggests that the scientific community should prioritize this group as a potentially treatable cause of ID. Here we summarize the recent expansion and major characteristics of MDEMs, as well as the unique therapeutic prospects for this group of disorders.Icelandic Research Fund
Hartwell Foundation
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
Louma G. Foundatio
Stress-related disorders – a major challenge of 21st century medical sciences
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The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery
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
Ósæðardæla eykur blóðflæði um kransæðar í þanbili og auðveldar vinnu hjartans við að tæma sig í slagbili. Hún er einkum notuð við bráða hjartabilun, en í minnkandi mæli við hjartabilun eftir opnar hjartaskurðaðgerðir þar sem umdeilt er hvort notkun hennar bæti horfur sjúklinga. Tilgangur þessarar rannsóknar var að kanna tíðni, ábendingar og árangur notkunar ósæðardælu í tengslum við kransæðahjáveituaðgerðir á Íslandi.
EFNIVIÐUR OG AÐFERÐIR
Rannsóknin var afturskyggn og náði til 2177 sjúklinga sem gengust undir kransæðahjáveituaðgerð á Landspítala á tímabilinu 2001-2018. Sjúklingar sem fengu ósæðardælu voru bornir saman við sjúklinga í viðmiðunarhópi með ein- og fjölþáttagreiningu. Langtímalifun og langtímafylgikvillar voru áætluð með aðferð Kaplan- Meiers.
NIÐURSTÖÐUR
Alls fengu 99 (4,5%) sjúklingar ósæðardælu og var tíðnin hæst árið 2006 (8,9%) en lægst 2001 (1,7%) og breyttist ekki marktækt yfir rannsóknartímabilið (p=0,90). Flestir fengu ósæðardælu fyrir (58,6%) eða í (34,3%) aðgerð, en aðeins 6,1% eftir aðgerð. Heildartíðni fylgikvilla var 14,1% og var blæðing frá ísetningarstað algengasti kvillinn (4,0%). Tíðni fylgikvilla og 30 daga dánartíðni var hærri í ósæðardæluhópi en viðmiðunarhópi (22,2% á móti 1,3%, p<0,001) og heildarlifun 5 árum eftir aðgerð reyndist síðri (56,4% á móti 91,5%, 95% ÖB: 0,47-0,67) sem og 5 ára MACCE-frí lifun (46,9% á móti 83,0%, 95% ÖB: 0,38-0,58).
ÁLYKTUN
Innan við 5% sjúklinga fengu ósæðardælu í tengslum við kransæðahjáveitu á Íslandi og hefur hlutfallið lítið breyst á síðastliðnum 18 árum. Tíðni fylgikvilla og 30 daga dánartíðni var hærri hjá sjúklingum sem fengu ósæðardælu og bæði langtíma- og MACCE- frí lifun þeirra umtalsvert síðri, sem sennilega skýrist af alvarlegra sjúkdómsástandi þeirra sem fengu dæluna.Introduction: Intra-aortic balloon pump (IABP) is a mechanical device that increases cardiac output by increasing diastolic blood flow to the coronary arteries and lowers the afterload of the left ventricle in systole. IABP is primarily used in acute heart failure, that includes patients that have to undergo coronary artery bypass grafting (CABG). Its usage, however, in cardiac surgery has been declining with ongoing controversy regarding its benefits. The aim of this study was to assess the use and indications and outcome of IABP related to CABG surgery.
Material and Methods: The study was retrospective and included 2177 patients that underwent CABG at Landspítali during 2001-2018. We compared those who received an IABP with controls, using uni- and multivariate analysis. Long term survival and complications (major adverse cardiovascular and cerebral events, MACCE) was estimated with Kaplan-Meier method.
Results: A total of 99 (4.5%) patients received an IABP. The incidence was highest in 2006 (8.9%) and lowest in 2001 (1.7%), but the incidence did not change during the study period (p=0.90). Most patients received the pump before (58.6%) or during (34.3%) CABG, but only 6.1% after surgery. Complication rate was 14.1%, with bleeding from the insertion site in the groin being the most common complication. Thirty day mortality was higher in the IABP group compared with controls (22.2% vs 1.3%, p<0.001) and both 5-year survival (56.4% vs 91.5%, 95% CI: 0.47-0.67) and 5-year MACCE-free survival (46.9% vs 83.0%, 95% CI: 0.38-0.58) were inferior.
Conclusions: Less than 5% of patients received IABP in relation to CABG in Iceland and the rate hasn't changed much for the last 18 years. Both the complication rate and 30-day mortality was higher in patients in IABP group and both the long term and MACCE-free survival was much worse, probably mostly related to worse overall clinical condition of the patient that received IABP.Vísindasjóður Landspítala, Rannsóknarsjóður Háskóla Íslands og Minningarsjóður Helgu Jónsdóttur og Sigurliða Kristjánssonar
Health of high-school adolescents: pilot testing of the clinical screening tool hEiLung
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: unglingsárin eru tími mikilla breytinga og áhættuhegðun
algeng. Tilgangur þessarar rannsóknar var að forprófa nýtt klínískt
skimunartæki sem nefnist hEiLung og ætlað er að meta heilbrigði
unglinga í framhaldsskólum, bæði verndandi þætti og áhættuþætti/
áhættuhegðun og að skoða hagnýtt gildi þess.
Aðferð: gerð var forprófun á hEiLung og tekin þrjú viðtöl við
skólahjúkrunarfræðing um notkun tækisins. Skólahjúkrunarfræðingur í einum framhaldsskóla í reykjavík safnaði gögnum. Stuðst var
við tilgangsúrtak og voru þátttakendur þeir nemendur sem leituðu
til skólahjúkrunarfræðings til heilsueflingar vorið 2016. gerð var
þáttagreining, fylgniútreikningar og tilgátuprófanir. Viðtöl við skólahjúkrunarfræðinginn voru skráð og greind eftir fyrirframákveðnum
efnisþáttum.
Niðurstöður: Þátttakendur voru 68 nemendur á aldrinum 15–20 ára;
meðalaldur 17,9 ár, 76% voru stúlkur og 24% piltar. Þáttagreining
leiddi í ljós tvo þætti: sjálfsmynd og sjálfstrú, en ekki reyndist unnt
að þáttagreina áhættuþætti/áhættuhegðun. innra samræmi þáttagreiningarinnar reyndist vera yfir α=0,8 fyrir báða þættina. fylgni
var á milli þáttanna sjálfsmyndar og sjálfstrúar en ekki á milli verndandi þátta og áhættuþátta/áhættuhegðunar. niðurstöður renna
stoðum undir hugsmíðaréttmæti verndandi þátta. Viðtöl við skólahjúkrunarfræðing gáfu til kynna að skimunartækið væri auðvelt í
notkun og að það gæfi heildrænni mynd af heilbrigði unglingsins en
hefðbundin viðtöl.
Ályktanir: forprófunin gefur góðar vísbendingar um áreiðanleika
og hugsmíðaréttmæti skimunartækisins hvað varðar verndandi þætti
en þörf er á því að prófa það áfram og leggja fyrir stærra úrtak til að
skoða betur áhættuþætti og áhættuhegðun. Skimunartækið er auðvelt í notkun og gefur heildræna mynd af heilbrigði unglingsins.Aim: adolescence is a time of great change and frequent risk-taking. The purpose of the current study was to pilot test the new
clinical screening tool hEiLung, designed to assess the health of
adolescents in high schools, with regard to protective factors and
risk factors/risk behavior, also to determine its practical value.
Method: a pilot study of hEiLung was conducted along with
three interviews with a school nurse. Data collection was carried
out by a school nurse in one high school in reykjavík. a purposive
sample was used and those students who came to the school nurse
for health related reasons in spring 2016 were invited to participate. factor analysis, correlation and hypothesis testing were performed. interviews with the school nurse were transcribed and
classified based on preset categories.
Results: Participantswere 68 students 15–20 years old; mean agewas
17,9 years, 76% were female and 24% male. factor analysis revealed
two factors:self-concept and self-efficacy. risk factors/risk behavior
could not be factor analysed. The internal consistency was found
to be above α=0.8 for both factors. Correlation was found between
the self-image and self-efficacy but not between protective factors
and risk factors/risk behavior. The results supported the construct
validity of the protective factors. interviews with the school nurse
indicated the instrument was easy to use and it gave more comprehensive view of adolescents health than the standard interview.
Conclusion: The pilot study yielded positive indications about the
reliability and construct validity of the screening tool hEiLung
regarding protective factors. however, further studies need to be
carried out with a larger sample for a better understanding of the
risk factors/risk behavior. The screening tool hEiLung is easy to
use and gives a comprehensive picture of adolecents’ health.Forvarnarsjóður Reykjavíku
RETINAL OXIMETRY IS ALTERED IN EYES WITH CHOROIDAL MELANOMA BUT NOT IN EYES WITH CHOROIDAL NEVI.
No full textTo access publisher's full text version of this article click on the hyperlink belowPurpose: To compare retinal vessel oxygenation in eyes with an untreated choroidal nevus or choroidal melanoma.
Methods: The affected and fellow eye of patients with an untreated choroidal nevus (n = 42) or choroidal melanoma (n = 45) were investigated using noninvasive retinal oximetry (Oxymap T1). Oxygen saturation of arterioles (ArtSat) and venules (VenSat) was determined, together with the arteriovenous difference (AV-difference).
Results: In choroidal nevus patients, retinal oximetry did not differ between the affected and fellow eye: the mean ArtSat was 94.5% and 94.2% (P = 0.56), the VenSat was 60.5% and 61.3% (P = 0.35), and the AV-difference was 34.0% and 32.9% (P = 0.18), respectively. In choroidal melanoma patients, alterations were detected: the mean ArtSat was 94.8% and 93.2% (P = 0.006), the VenSat was 58.0% and 60.0% (P = 0.014), and the AV-difference was 36.8% and 33.2% (P < 0.001), respectively. The largest increase in AV-difference was observed between the retinal halves without the lesion in melanoma eyes compared with the corresponding half in the fellow eye (37.5% vs. 32.1%, P < 0.001).
Conclusion: Although retinal oximetry was not significantly altered in eyes with a choroidal nevus, eyes with choroidal melanoma showed an increased ArtSat and decreased VenSat, leading to an increased AV-difference. These changes may be caused by inflammation and a higher metabolism, with larger oxygen consumption, leading to altered blood flow and intraocular oxygen relocation.Leiden University Medical Center
Stichting Nederlands Oogheelkundig Onderzoek (SNOO