liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Kalman, Sigga
Publications (10 of 26) Show all publications
Nilsson, A., Kalman, S., Arvidsson, A. & Sjöberg, F. (2011). Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns. JOURNAL OF BURN CARE and RESEARCH, 32(1), 166-171
Open this publication in new window or tab >>Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns
2011 (English)In: JOURNAL OF BURN CARE and RESEARCH, ISSN 1559-047X, Vol. 32, no 1, p. 166-171Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no pain and 10 = unbearable pain), patients were asked to estimate their acceptable and worst experienced pain by specifying a number on a scale and at what point they would like additional analgesics. Patients were allowed free access to morphine with a PCA pump device. Bolus doses were set according to age, (100 - age)/24 = bolus dose (mg), and 6 minutes lockout time. Degrees of pain, morphine requirements, doses delivered and demanded, oral intake of food, and antiemetics given were used as endpoints. Acceptable pain (mean [SD]) was estimated to be 3.8 (1.3) on the NRS, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean morphine per day was 81 (15) mg, and the number of doses requested increased during the first 6 days after the burn. The authors found no correlation between dose of morphine required and any other variables. Background pain can be controlled adequately with a standard PCA protocol. During mobilization, the pain experienced was too intense, despite having the already high doses of morphine increased. The present protocol must be refined further to provide analgesia adequate to cover mobilization as well.

Place, publisher, year, edition, pages
Lippincott Williams andamp; Wilkins, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-66135 (URN)10.1097/BCR.0b013e31820334e5 (DOI)000285996000029 ()
Note
Original Publication: Andreas Nilsson, Sigga Kalman, Anders Arvidsson and Folke Sjöberg, Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns, 2011, JOURNAL OF BURN CARE and RESEARCH, (32), 1, 166-171. http://dx.doi.org/10.1097/BCR.0b013e31820334e5 Copyright: Lippincott Williams & Wilkins http://www.lww.com/Available from: 2011-03-04 Created: 2011-03-04 Last updated: 2012-03-27Bibliographically approved
Bartha, E., Rudin, Å., Flisberg, P., Lundberg, C., Carlsson, P. & Kalman, S. (2008). Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?. Acta Anaesthesiologica Scandinavica, 52(10), 1313-1318
Open this publication in new window or tab >>Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?
Show others...
2008 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 10, p. 1313-1318Article in journal (Refereed) Published
Abstract [en]

Background: A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post-operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high-risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post-operative costs of intensive care in patients receiving epidural or intravenous analgesia.

Methods: Clinical data and rates of post-operative complications were extracted from a previously reported trial following thoraco-abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care.

Results: Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros/patient, were outweighed by lower post-operative costs of intensive care 5,571 vs. 7,921 Euros/patient (NS).

Conclusion: Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post-operative care following major surgery.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45321 (URN)10.1111/j.1399-6576.2008.01734.x (DOI)81311 (Local ID)81311 (Archive number)81311 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Nilsson, L., Goscinski, T., Johansson, A., Lindberg, L.-G. & Kalman, S. (2006). Age and gender do not influence the ability to detect respiration by photoplethysmography. Journal of clinical monitoring and computing, 20(6), 431-436
Open this publication in new window or tab >>Age and gender do not influence the ability to detect respiration by photoplethysmography
Show others...
2006 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 20, no 6, p. 431-436Article in journal (Refereed) Published
Abstract [en]

Objective  The non-invasive technique photopl- ethysmography (PPG) can detect changes in blood volume and perfusion in a tissue. Respiration causes variations in the peripheral circulation, making it possible to monitor breaths using an optical sensor attached to the skin. The respiratory-synchronous part of the PPG signal (PPGr) has been used to monitor respiration during anaesthesia, and in postoperative and neonatal care. Studies addressing possible differences in PPGr signal characteristics depending on gender or age are lacking.

Methods  We studied three groups of 16 healthy subjects each during normal breathing; young males, old males and young females, and calculated the concordance between PPGr, derived from a reflection mode PPG sensor on the forearm, and a reference CO2 signal. The concordance was quantified by using a squared coherence analysis. Time delay between the two signals was calculated. In this process, we compared three different methods for calculating time delay.

Results  Coherence values ≥0.92 were seen for all three groups without any significant differences depending on age or gender (p = 0.67). Comparison between the three different methods for calculating time delay showed a correlation r = 0.93.

Conclusions  These results demonstrate clinically important information implying the possibility to register qualitative PPGr signals for respiration monitoring, regardless of age and gender.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37154 (URN)10.1007/s10877-006-9050-z (DOI)33808 (Local ID)33808 (Archive number)33808 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2018-03-23Bibliographically approved
Kalman, S., Ekbäck, G., Nilsson, L., Metcalf, K. & Ranklev Twetman, E. (2006). Anestesiläkarnas arbetsmiljö kan förbättras. Slutrapport från ett arbetsmiljöprojekt. Läkartidningen, 103, 1603-1610
Open this publication in new window or tab >>Anestesiläkarnas arbetsmiljö kan förbättras. Slutrapport från ett arbetsmiljöprojekt
Show others...
2006 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 1603-1610Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-37164 (URN)33828 (Local ID)33828 (Archive number)33828 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Bartha, E., Carlsson, P. & Kalman, S. (2006). Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery. British Journal of Anaesthesia, 96(1), 111-117
Open this publication in new window or tab >>Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery
2006 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 96, no 1, p. 111-117Article in journal (Refereed) Published
Abstract [en]

Background. The outcome of different treatment strategies for postoperative pain has been an issue of controversy. Apart from efficacy and effectiveness a policy decision should also consider cost-effectiveness. Since economic analyses on postoperative pain treatment are rare we developed a decision model in a pilot cost-effectiveness analysis (CEA) comparing epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) after major abdominal surgery in routine care. Methods. Using a decision-tree model, treatment with EDA (ropivacaine and morphine) was compared with PCIA (morphine). Effects and costs of treatment were established. The number of pain-free days at rest (pain intensity <30 using visual analogue scale 1-100 mm) was the primary measure of effect. An incremental cost-effectiveness ratio (ICER) was calculated as the difference in direct costs divided by the difference in effect. A database on 644 patients collected for the purpose of quality control during the period of 1997 to 1999 was the main data source. Sensitivity analysis was used to test uncertain data. Results. EDA was more effective in terms of pain-free days but more expensive. The additional cost for each pain-free day was 5652 Euros. Conclusion. It is a judgement of value if the additional cost is reasonable. When the cost of around 55 000 Euros per gained life-year with full health for other interventions is debated, our result indicates poor cost-effectiveness for EDA. Before any conclusion can be drawn concerning policy recommendations the difference in costs has to be related to other outcome measures as length of hospital stay, morbidity and mortality are required. © The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33856 (URN)10.1093/bja/aei270 (DOI)19929 (Local ID)19929 (Archive number)19929 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Bartha, E., Kalman, S. & Carlsson, P. (2006). Postoperativ smärtlindring - till vilket pris?: En hälsoekonomisk modellanalys av två smärtlindringsmetoder. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Postoperativ smärtlindring - till vilket pris?: En hälsoekonomisk modellanalys av två smärtlindringsmetoder
2006 (Swedish)Report (Other academic)
Abstract [sv]

Utgångspunkten för denna rapport var en kvalitetskontroll av rutiner för postoperativ smärtlindring vid Anestesikliniken på US i Linköping under 1997-1999. Vid denna kontroll upptäckte vi en del svagheter i rutiner, bl.a. att epiduralsmärtlindring avslutades tidigare än avsetts i högre frekvens än väntat. Under denna period registrerades en mängd uppgifter om aktuell behandling och olika utfall i en databas. Resultatet pekade på att den mest använda metoden i praktiken var förenad med extrainsatser som bidrog till högre kostnader. Denna kunskap ledde fram till en vidare frågeställning än vad som traditionellt diskuterats i dessa sammanhang nämligen hur de aktuella metoderna förhåller sig till varandra när även kostnader för behandlingen tas i beaktande. Det första steget att besvara denna fråga var ett projektarbete i kursen om Klinisk Utvärderingsvetenskap (KLUV) som anordnades av Linköpings universitet med stöd av Forskningsrådet i Sydvästra Sjukvårdsregionen. Studien har sedan vidareutvecklats och färdigställts vid CMT med ekonomiskt stöd från Landstinget i Östergötland.

Syftet med rapporten är att belysa hur två metoder för postoperativ smärtlindring (epiduralbedövning och intravenös opioidbehandling med patientkontrollerad pump) fungerar i vardagssjukvård med hänsyn tagen till både kostnader och effekten på smärta. Frågan om vilken metod som är den bättre av dessa har diskuterats under senaste decenniet. Epiduralbedövning tycks ge bättre smärtlindring, men det är oklart vilket mervärde som den skillnaden i smärtintensitet ger oavsett om den mäts som patientupplevd, medicinsk eller samhällelig nytta. Frågan om vilken behandlingsform som är mest kostnadseffektiv är intressant eftersom den här typen av smärtlindring är vanlig och berör ett stort antal patienter i sjukvården. Vår förhoppning är att vi med hjälp av denna hälsoekonomiska modellanalys av beslutsproblemet kan bidra till ett bättre beslutsunderlag men också väcka ett intresse för att göra hälsoekonomiska utvärderingar av smärtlindringsmetoder vilket hittills varit relativt ovanligt.

Studien har genomförts i samarbete mellan CMT och AnOp Centrum vid US i Linköping. Flera personer har bidragit till denna rapport och vi vill tacka Mona Lindblad och Lilian Adamsson som var ansvariga för databasen under åren 1997-1999. Vi vill vidare tacka Martin Henriksson vid CMT för värdefulla synpunkter.

Abstract [en]

The  common  method  for  postoperative  pain  control  after  major  abdominal surgery in routine care is epidural analgesia (EDA) using a combination of local anaesthetics  with  opiate  and  patient-controlled   intravenous  analgesia  using opiate (PCIA). It is a matter of dispute which method is better and should be favoured in different clinical situations. The superior analgesic effect of epidural analgesia reported in clinical trials has been difficult to transform into clinical practice.  In a large number  of patients  the epidural  analgesia  is discontinued earlier  than planned  because  of technical  difficulties.  The influence  of better analgesic effect on outcome in terms of mortality and morbidity has also been an issue  of  controversy.  There  are  no  clear  recommendations  which  treatment should  be  selected  in  specific  situations.  According  to  the  guidelines  of  the Swedish  Society  of Anaesthesiology  both  EDA  and  PCIA  can  be chosen  in several  situations.  Apart  from  efficacy  and  effectiveness  a  policy  decision should    also    consider    cost-effectiveness.    Since    economic    analyses    on postoperative pain treatment are rare an analysis of costs and consequences of planned  and discontinued  treatment  is of interest  when  comparing  these  two strategies. The aim of this report is to estimate cost-effectiveness  of treatment with EDA and PCIA under clinical circumstances by a decision analytic model using a clinical database as datasource.

Using   a   decision-tree,   treatment   with   EDA   was   compared   with   PCIA (morphine) by describing the possible clinical pathways for the successful and early-terminated treatments. The length of treatment was 3 days. A database on 644 patients collected for the purpose of quality control during 1997-99 was the main data source. By using the model costs and effects were established. The effects were expressed as number of pain-free days and the costs in Swedish krona (SEK). Number of pain-free days at rest (pain intensity<30 using visual analogue  scale  1-100  mm)  was  the  primary  measure  of  effect.  The  cost- effectiveness,  the average cost for reaching a particular outcome with a given treatment, is expressed as cost-effectiveness ratio (CER). When decision has to be  taken  to  replace  a  treatment  with  a  more  expensive  and  more  effective treatment, an estimate of the additional resources that have to be used to obtain the additional benefit is needed. That is the incremental cost-effectiveness ratio (ICER).

The result of the main analysis is that the cost for each pain-free day is 6.489 SEK for treatment with EDA and 2.602 SEK for PCIA. The incremental cost- effectiveness  ratio  is  50.215  SEK.  This  is  the  additional  cost  for  each  of additional  pain-free  day in a situation  when treatment  strategy  from PCIA is converted to EDA. The sensitivity analysis of our result shows that the result of the cost analysis is robust. However changes in assumptions of effect size have substantial impact on the result*.

*  See  an  English  version  of  the  report.  Bartha  E,  Carlsson  P,  Kalman  S. Evaluation  of  costs  and  effects  of  epidural  analgesia  and  patient-controlled intravenous  analgesia after major abdominal  surgery. Br J Anaesth. 2005 Oct 28; [Epub ahead of print]

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2006. p. 42
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2006:1
Keywords
Health care costs, pain-therapy, Hälsoekonomi, smärtlindring
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33857 (URN)LIU CMT RA/0601 (ISRN)19930 (Local ID)19930 (Archive number)19930 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2018-03-21Bibliographically approved
Nilsson, L., Goscinski, T., Kalman, S., Lindberg, L.-G. & Johansson, A. (2005). Detection of breaths by photoplethysmography is independent of age and sex. In: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005 (pp. 19).
Open this publication in new window or tab >>Detection of breaths by photoplethysmography is independent of age and sex
Show others...
2005 (English)In: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005, 2005, p. 19-Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-32145 (URN)18010 (Local ID)18010 (Archive number)18010 (OAI)
Available from: 2009-10-09 Created: 2009-10-09
Alkaissi, A., Ledin, T., Ödkvist, L. & Kalman, S. (2005). P6 acupressure increases tolerance to nausogenic motion stimulation in women with high risk for PONV. Canadian Journal of Anesthesia, 52, 703-709
Open this publication in new window or tab >>P6 acupressure increases tolerance to nausogenic motion stimulation in women with high risk for PONV
2005 (English)In: Canadian Journal of Anesthesia, ISSN 1496-8975, Vol. 52, p. 703-709Article in journal (Refereed) Published
Abstract [en]

Purpose: In a previous study we noticed that P6 acupressure decreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acu-pressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.

Methods: 60 women with high and low susceptibilities for motion sickness participated in a randomized and double-blind study with an active P6 acupressure, placebo acupressure, and a control group (n = 20 in each group). The risk score for PONV was over 50%. The motion challenge was by eccentric rotation in a chair, blindfolded and with chin to chest movements of the head. The challenge was stopped when women reported moderate nausea. Symptoms were recorded.

Results: Mean time to moderate nausea was longer in the P6 acu-pressure group compared to the control group. P6 acupressure = 352 (259–445), mean (95% confidence interval) in seconds, control = 151 (121–181) and placebo acupressure = 280 (161–340); (P = 0.006). No difference was found between P6 and placebo acupressure or placebo acupressure and control groups. Previous severity of motion sickness did not influence time to nausea (P = 0.107). The cumulative number of symptoms differed between the three groups (P < 0.05). Fewer symptoms were reported in the P6 acupressure compared to the control group P < 0.009. Overall, P6 acupressure was only marginally more effective than placebo acupressure on the forearms.

Conclusion: In females with a history of motion sickness P6 acu-pressure increased tolerance to experimental nauseogenic stimuli, and reduced the total number of symptoms reported.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13651 (URN)
Available from: 2004-05-20 Created: 2004-05-20 Last updated: 2009-08-17
Nilsson, L., Goscinski, T., Kalman, S., Lindberg, L.-G. & Johansson, A. (2005). Photoplethysmography for central and obstructive apnea detection. In: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005 (pp. 19).
Open this publication in new window or tab >>Photoplethysmography for central and obstructive apnea detection
Show others...
2005 (English)In: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005, 2005, p. 19-Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-32143 (URN)18008 (Local ID)18008 (Archive number)18008 (OAI)
Available from: 2009-10-09 Created: 2009-10-09
Nilsson, L., Johansson, A. & Kalman, S. (2005). Respiration can be monitored by photoplethysmography with high sensitivity and specificity regardless of anaesthesia and ventilatory mode. Acta Anaesthesiologica Scandinavica, 49(8), 1157-1162
Open this publication in new window or tab >>Respiration can be monitored by photoplethysmography with high sensitivity and specificity regardless of anaesthesia and ventilatory mode
2005 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 8, p. 1157-1162Article in journal (Refereed) Published
Abstract [en]

Background:  Photoplethysmography (PPG) is a non-invasive optical technique used, for instance, in pulse oximetry. Beside the pulse synchronous component, PPG has a respiratory synchronous variation (PPGr). Efforts have been made to utilize this component for indirect monitoring of respiratory rate and volume. Assessment of the clinical usefulness as well as of the physiological background of PPGr is required. We evaluated if anaesthesia and positive-pressure ventilation would affect PPGr.

Methods:  We recorded reflection mode PPGr, at the forearm, and the respiratory synchronous changes in central venous pressure (CVP), peripheral venous pressure (PVP) and arterial blood pressure (ABP) in 12 patients. Recordings for each patient were made on three occasions: awake with spontaneous breathing; anaesthetized with spontaneous breathing; and anaesthetized with positive-pressure ventilation. We analyzed the sensitivity, specificity, coherence and time relationship between the signals.

Results:  PPGr sensitivity for breath detection was [mean (SD)] >86(21)% and specificity >96(12)%. Respiratory detection in the macrocirculation (CVP, PVP and ABP) showed a sensitivity >83(29)% and specificity >93(12)%. The coherence between signals was high (0.75–0.99). The three measurement situations did not significantly influence sensitivity, specificity or time shifts between the PPGr, PVP, ABP, and the reference CVP signal despite changes in physiological data between measurements.

Conclusion:  A respiratory synchronous variation in PPG and all invasive pressure signals was detected. The reflection mode PPGr signal seemed to be a constant phenomenon related to respiration regardless of whether or not the subject was awake, anaesthetized or ventilated, which increases its clinical usefulness in respiratory monitoring.

Keywords
general anaesthesia, monitoring, photoplethysmography, positive-pressure ventilation, respiration
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31542 (URN)10.1111/j.1399-6576.2005.00721.x (DOI)17342 (Local ID)17342 (Archive number)17342 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
Organisations

Search in DiVA

Show all publications