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  • 101.
    Svernlöv, Birgitta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nylander, Göran
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Patient-reported outcome of surgical treatment of nerve entrapments in the proximal forearm2011In: Advances in orthopedics, ISSN 2090-3472, Vol. 2011, p. 727689-Article in journal (Refereed)
    Abstract [en]

    The outcome of decompression for long-standing symptoms of nerve entrapments in the proximal forearm was investigated in a retrospective study of 205 patients using a self-assessment questionnaire, 45 months after the operation. The questionnaire consisted of visual analogue scale recordings of pre- and postoperative pain during rest and activity, questions about remaining symptoms and appreciation of the result and the Disabilities of Arm, Shoulder and Hand form (DASH). Altogether, 59% of the patients were satisfied, 58% considered themselves improved, and 3% as being entirely relieved of all symptoms. Pain decreased significantly (P = 0.001). There was a significant correlation between preoperative duration and patient perceived post-operative pain. Preoperative pain was a chief complaint, and pain reduction appears to be the principal gain of the operation. Although the majority of the patients benefited from the operation, a substantial proportion was not satisfied. There is apparently room for improvement of the diagnostic and surgical methods applied in this study.

  • 102.
    Tchou Folkesson, Kim
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Samuelsson, Anders
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Dahlström, Bengt
    AB Biopharmacon, Uppsala.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    A Human Vascular Model Based on Microdialysis for the Assessment of the Vasoconstrictive Dose-Response Effects of Norepinephrine and Vasopressin in Skin2012In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 19, no 4, p. 352-359Article in journal (Refereed)
    Abstract [en]

    Abstract Objective: Microdialysis enables drug delivery in the skin and simultaneous measurement of their effects. The present study aimed to evaluate dose-dependent changes in blood flow and metabolism during microdialysis of norepinephrine and vasopressin. Methods: We investigated whether increasing concentrations of norepinephrine (NE, 1.859 mu mol/L) and vasopressin (VP, 1100 nmol/L), delivered sequentially in one catheter or simultaneously through four catheters, yield dose-dependent changes in blood flow (as measured using urea clearance) and metabolism (glucose and lactate). Results: We found a significant dose-dependent vasoconstriction with both drugs. Responses were characterized by a sigmoid dose response model. Urea in the dialysate increased from a baseline of 7.9 +/- 1.7 to 10.9 +/- 0.9 mmol/L for the highest concentration of NE (p andlt; 0.001) and from 8.1 +/- 1.4 to 10.0 +/- 1.7 mmol/L for the highest concentration of VP (p = 0.037). Glucose decreased from 2.3 +/- 0.7 to 0.41 +/- 0.18 mmol/L for NE (p = 0.001) and from 2.7 +/- 0.6 to 1.3 +/- 0.5 mmol/L for VP (p andlt; 0.001). Lactate increased from 1.1 +/- 0.4 to 2.6 +/- 0.5 mmol/L for NE (p = 0.005) and from 1.1 +/- 0.4 to 2.6 +/- 0.5 mmol/L for VP (p = 0.008). There were no significant differences between responses from a single catheter and from those obtained simultaneously using multiple catheters. Conclusions: Microdialysis in the skin, either with a single catheter or using multiple catheters, offers a useful tool for studying dose response effects of vasoactive drugs on local blood flow and metabolism without inducing any systemic effects.

  • 103.
    Tesselaar (Droog), Erik
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Henricson, Joakim
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Jonsson, Susanne
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    A time–response model for analysis of drug transport and blood flow response during iontophoresis of acetylcholine and sodium nitroprusside2009In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 46, no 4, p. 270-277Article in journal (Refereed)
    Abstract [en]

    Background/Aims: The analysis of blood flow responses to iontophoresis of vasoactive drugs is often limited to evaluation of maximum responses. In this study, a time-response model is proposed for the blood flow responses to vasoactive drugs applied by iontophoresis.

    Methods: The microvascular bed is represented as a single compartment with a zero-order influx of the drugs from the electrode and a first-order clearance due to diffusion and blood flow. The blood flow response to the local drug dose is described using the Emax model.

    Results: The model accurately describes the blood flow responses to acetylcholine and sodium nitroprusside during a single iontophoretic current pulse. There is a significant clearance out of the microvascular bed during iontophoresis which depends on the type of drug administered.

    Conclusion: The model enables an accurate estimation of response parameters such as ED50 and maximum response, even if the true maximum blood flow is not obtained. The results suggest that due to clearance from the microvascular bed, the local drug dose during a single pulse of current is not linearly proportional to current strength multiplied by pulse duration.

  • 104.
    Tesselaar, Erik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Bergkvist, Max
    Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Polarized Light Spectroscopy for Measurement of the Microvascular Response to Local Heating at Multiple Skin Sites2012In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 19, no 8, p. 705-713Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate whether TiVi, a technique based on polarized light, could measure the change in RBC concentration during local heating in healthy volunteers. Methods: Using a custom-made transparent heater, forearm skin was heated to 42 degrees C for 40 minutes while the change in RBC concentration was measured with TiVi. The perfusion response during local heating was measured at the same time with Laser Doppler flowmetry. Results: Mean RBC concentration increased (91 +/- 34 vs. 51 +/- 34 A.U. at baseline, p less than 0.001). The spatial heterogeneity of the RBC concentration in the measured skin areas was 26 +/- 6.4% at baseline, and 23 +/- 4.6% after 40 minutes of heating. The mean RBC concentrations in two skin sites were highly correlated (0.98 at baseline and 0.96 after 40 minutes of heating). The change in RBC concentration was less than the change in perfusion, measured with LDF. Unlike with LDF, a neurally mediated peak was not observed with TiVi in most of the test subjects. Conclusions: TiVi is a valuable technique for measuring the microvascular response to local heating in the skin, and offers a high reproducibility for simultaneous measurements at different skin sites, provided carefully controlled experiments are ensured.

  • 105.
    Tesselaar, Erik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Measurement of red blood cell concentration in skin during vascular provocations using polarization light spectroscopy imaging in JOURNAL OF VASCULAR RESEARCH, vol 48, issue , pp 164-1642011In: JOURNAL OF VASCULAR RESEARCH, Karger , 2011, Vol. 48, p. 164-164Conference paper (Refereed)
    Abstract [en]

    n/a

  • 106.
    Tesselaar, Erik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Sarker, Saikat
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Assessment of the microvascular effect of insulin using transdermal iontophoresis: optimizing drug delivery in JOURNAL OF VASCULAR RESEARCH, vol 48, Suppl. 1, Poster Session II/2, pp 127-1272011In: JOURNAL OF VASCULAR RESEARCH / [ed] Ulrich Pohl and Markus Sperandio, Karger , 2011, Vol. 48, p. 127-127Conference paper (Refereed)
    Abstract [en]

    Transdermal delivery by iontophoresis has been used previously to study the vascular effects of insulin in the cutaneous microcirculation. Although a vasodilatory effect of iontophoretically applied insulin has been shown, the observed increases in perfusion, as measured using laser Doppler flowmetry, are modest, possibly since delivered doses are limited due to the electrochemical properties of the molecule, and the relatively low permeability of the skin.

    Ethanol, urea and depilatory agents have previously been used to enhance transport of substances during iontophoresis. In this pilot study in 8 healthy volunteers, we aimed to investigate the effect of insulin on skin perfusion, as measured by laser-Doppler flowmetry. We tested various strategies that could possibly enhance the delivery of insulin to the skin using iontophoresis, including the use of an insulin analog (insulin aspart), pretreatment of the skin with ethanol and depilatory cream and using 50%/50% mixtures of insulin/ethanol and insulin/urea.

    Although a slight increase in skin perfusion was found in most subjects with iontophoresis of regular insulin using a single 10-minute current pulse of 0.02 mA (12 mC, N=4), this effect was not significant. Neither of the two pretreatment methods affected this effect. However, when using 9 x 20sec current pulses of 0.2 mA (36 mC, N=4), and when the drugs were mixed with ethanol in a 50%/50% fraction , a 15- to 17-fold increase in perfusion was found for insulin aspart (p=0.04). Iontophoresis of a control substance (50%/50% ethanol/sodium chloride) did not have any effect on skin perfusion (p=0.32). Similarly, iontophoresis of a mixture of urea and insulin aspart yielded a 14-fold increase in perfusion (p=0.03), while a non significant increase in perfusion was found when urea was mixed with regular insulin (p=0.08) and no change at all with sodium chloride (control, p=0.27).

    These results indicate that iontophoretic transport of insulin may be enhanced by using mixtures of insulin with ethanol or urea, which may facilitate studies that use iontophoresis to study the vascular effects of insulin in the cutaneous microcirculation. Further studies, for instance using microdialysis, are required to directly measure the delivered dose of insulin during iontophoresis under different conditions.

  • 107.
    Tesselaar, Erik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Transdermal iontophoresis as an in-vivo technique for studying microvascular physiology2011In: MICROVASCULAR RESEARCH, ISSN 0026-2862, Vol. 81, no 1, p. 88-96Article in journal (Refereed)
    Abstract [en]

    Assessment of microvascular function is of major importance in understanding the physiology of the vasculature and in investigating the vascular effects of pathological conditions. Transdermal iontophoresis can be used to non-invasively introduce vasoactive drugs into the skin. The response of the local cutaneous microvasculature to these drugs can be measured by methods such as laser Doppler flowmetry. Although the technique has been used for over two decades, there are still important methodological issues to be resolved. This review describes the technique of iontophoresis as well as its development during recent years, while focusing on how iontophoresis can be used as an in-vivo model for studying physiologic mechanisms and on the analysis and interpretation of dose-response data.

  • 108.
    Thorfinn, Johan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Angelidis, I K
    Stanford University.
    Gigliello, L
    Stanford University.
    Pham, H M
    Stanford University.
    Lindsey, D
    Stanford University.
    Chang, J
    Stanford University.
    Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo2012In: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, ISSN 1753-1934, Vol. 37E, no 2, p. 109-114Article in journal (Refereed)
    Abstract [en]

    Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

  • 109.
    Tokarik, Monika
    et al.
    Charles University of Prague, Czech Republic .
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Balik, Martin
    Charles University of Prague, Czech Republic .
    Pafcuga, Igor
    Charles University of Prague, Czech Republic .
    Broz, Ludomir
    Charles University of Prague, Czech Republic .
    Fluid Therapy LiDCO Controlled Trial-Optimization of Volume Resuscitation of Extensively Burned Patients through Noninvasive Continuous Real-Time Hemodynamic Monitoring LiDCO2013In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 34, no 5, p. 537-542Article in journal (Refereed)
    Abstract [en]

    This pilot trial aims at gaining support for the optimization of acute burn resuscitation through noninvasive continuous real-time hemodynamic monitoring using arterial pulse contour analysis. A group of 21 burned patients meeting preliminary criteria (age range 18-75 years with second- third- degree burns and TBSA 10-75%) was randomized during 2010. A hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group), whereas those without LiDCO monitoring were defined as the control group. The modified Brooke/Parkland formula as a starting resuscitative formula, balanced crystalloids as the initial solutions, urine output of 0.5ml/kg/hr as a crucial value of adequate intravascular filling were used in both groups. Additionally, the volume and vasopressor/inotropic support were based on dynamic preload parameters in the LiDCO group in the case of circulatory instability and oligouria. Statistical analysis was done using t-tests. Within the first 24 hours postburn, a significantly lower consumption of crystalloids was registered in LiDCO group (P = .04). The fluid balance under LiDCO control in combination with hourly diuresis contributed to reducing the cumulative fluid balance approximately by 10% compared with fluid management based on standard monitoring parameters. The amount of applied solutions in the LiDCO group got closer to Brooke formula whereas the urine output was at the same level in both groups (0.8ml/kg/hr). The new finding in this study is that when a fluid resuscitation is based on the arterial waveform analysis, the initial fluid volume provided was significantly lower than that delivered on the basis of physician-directed fluid resuscitation (by urine output and mean arterial pressure). (J Burn Care Res 2013;34:537-542)

  • 110.
    Tokarik, Monika
    et al.
    Charles University of Prague, Czech Republic .
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Vajtr, David
    Charles University of Prague, Czech Republic .
    Broz, Ludomir
    Charles University of Prague, Czech Republic .
    Balik, Martin
    Charles University of Prague, Czech Republic .
    Vranova, Jana
    Charles University of Prague, Czech Republic .
    Natriuretic peptide proANP (1-98), a biomarker of ALI/ARDS in burns2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 2, p. 243-248Article in journal (Refereed)
    Abstract [en]

    Introduction: Plasma atrial natriuretic peptide levels (proANP (1-98)), a parameter of myocardial dysfunction, have been reported to be increased in critically ill patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The aim of the study was to examine if proANP is a biomarker of ALI/ARDS as assessed by the Sequential Organ Failure Assessment score (SOFA Lung andgt;= 2) in burn patients, and how it compares to the corresponding values for age, total body surface area percent (TBSA%) and inhalation injury for mortality prediction. less thanbrgreater than less thanbrgreater thanMethods: A group of 22 burn patients with a mean TBSA of 30% (10-75%) and a mean age of 52 years (25-84 years) was investigated during 2010. Organ dysfunction/failure was classified according to the SOFA score. The criteria for ALI/ARDS were based on SOFA Lung andgt;= 2. ProANP (1-98) concentrations (nmol l(-1)) were measured by commercially available enzyme linked immunosorbent assay (ELISA) immunoassays (Biomedica Austria) on post-bum days 2 and 7. less thanbrgreater than less thanbrgreater thanResults: ProANP levels on day 7 post-bum positively correlated with a SOFA score day 7 post-burn, c = 0.91. The receiver operating curve (ROC) analysis proved a sensitivity of 75% and a specificity of 75% for ALI/ARDS at cut-off values andgt; 3.35 nmol l(-1). The ROC value of proANP for ALI/ARDS (SOFA Lung andgt;= 2) was significantly larger than that of age, TBSA% and inhalation injury: 0.90, 0.71, 0.74, and 0.69 (p andlt; 0.001). less thanbrgreater than less thanbrgreater thanConclusions: ProANP levels, as a biomarker of ALI/ARDS, in critically burn patients correlated with SOFA scoring. The inhalation injury did not lead to increase in proANP values.

  • 111.
    Tønseth, Kim Alexander
    et al.
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Bjark, Therese
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Gross, Annika
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Kirschner, Rolf
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Schreiner, Thomas
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Diseth, Trond H.
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Haraldsen, Ira
    Oslo universitetssykehus, Rikshospitalet, Oslo, Norge.
    Kjønnskorrigerende kirurgived transseksualisme2010In: Tidsskrift for Den norske legeforening, ISSN 0029-2001, Vol. 130, no 4, p. 376-379Article, review/survey (Refereed)
    Abstract [no]

    Bakgrunn. Oslo universitetssykehus,Rikshospitalet har siden 1979 hattlandsfunksjon for behandling avpasienter med transseksualisme. Påårsbasis henvises 50–70 pasienter tilutredning, hvorav rundt 20 pasienterblir diagnostisert som transseksuelle.Årlig henvises omtrent 15 pasienter avdem som oppfyller kriterier for transseksualisme,og som er blitt endokrinologiskbehandlet, til kirurgisk intervensjon.I denne artikkelen beskrivesdiagnose og behandling av transseksualisme,med hovedvekt på kirurgi.Materiale og metode. Artikkelen erbasert på ikke-systematisk litteraturgjennomgangog egne kliniske og vitenskapeligeerfaringer.Resultater. Etter minimum ett årspsykiatrisk utredning og diagnostikk,og ett års påfølgende hormonellbehandling, vurderes pasientene i forholdtil kjønnskorrigerende kirurgi.Hos pasienter som konverteres framann til kvinne, vurderes brystforstørrendekirurgi hvis ikke hormonbehandlingalene har gitt tilfredsstillenderesultat. I tillegg er det aktuelt medgenital kirurgi hvor testikler og svamplegemenefjernes, og hvor neovaginaog neoklitoris konstrueres. For pasientersom konverteres fra kvinne tilmann, er det aktuelt å gjøre brystreduserendeinngrep, hysterektomi og salpingo-ooforektomi samt neopeniskonstruksjon.Ved god respons på hormonbehandlingkan klitoris rettes ut ogkonstrueres til en neopenis med ereksjonsmulighet(metoidioplastikk).Alternativt gjøres falloplastikk medbruk av lokalt vev fra lysken eller friemikrovaskulære lapper.Fortolkning. Kjønnskorrigerende kirurgived transseksualisme omfatterhovedsakelig konverterende operasjonerpå bryst og genitalia.

  • 112.
    Van Loey, Nancy E.
    et al.
    Assoc Dutch Burn Centre, Netherlands .
    Van de Schoot, Rens
    University of Utrecht, Netherlands .
    Gerdin, Bengt
    Uppsala University, Sweden .
    Faber, Albertus W.
    Martini Hospital, Netherlands .
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Willebrand, Mimmie
    Uppsala University, Sweden .
    The Burn Specific Health Scale-Brief: Measurement invariant across European countries2013In: JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, ISSN 2163-0755, Vol. 74, no 5, p. 1321-1326Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Burn Specific Health Scale Brief (BSHS-B), which is the only multidimensional measure to evaluate burn-specific aspects of health status, has previously been validated in several languages across the world. However, the stability of the underlying construct was not cross-culturally evaluated. The current study reports on measurement invariance across two samples of Swedish and Dutch-speaking patients with burns. less thanbrgreater than less thanbrgreater thanMETHODS: In a prospective study, 231 and 275 Swedish and Dutch-Belgian patients with burns, completed the BSHS-B at 9 or 12 months, respectively, after burn. Using a multigroup confirmatory factor analysis, measurement invariance across languages (Swedish and Dutch) was tested. less thanbrgreater than less thanbrgreater thanRESULTS: The results of the confirmatory factor analysis in the total sample revealed that the scale structure for the earlier reported three-factor structure and the original nine-factor structure was adequate. However, an eight-factor structure in which hand function and simple abilities were merged provided the best fit. This structure was used to test measurement invariance across the two language groups. The two-group outcomes testing measurement invariance across Swedish- and Dutch-speaking patients indicated a stable, configural invariance. less thanbrgreater than less thanbrgreater thanCONCLUSION: The BSHS-B seems to function uniformly across both language groups. The BSHS-B can be used to compare cross-cultural results in both countries.

  • 113.
    Wernerman, J.
    et al.
    Karolinska University Hospital.
    Kirketeig, T.
    Karolinska University Hospital.
    Andersson, B.
    Sahlgrens University Hospital.
    Berthelson, H.
    Kristianstad Hospital.
    Ersson, A.
    Skane University Hospital.
    Friberg, H.
    Skane University Hospital.
    Guttormsen, A.B.
    Bergen University Hospital.
    Hendrikx, S.
    Danderyd Hospital.
    Pettila, V.
    Helsinki University Hospital.
    Rossi, P.
    Karolinska University Hospital.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Winso, O.
    Norrland University Hospital.
    Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 7, p. 812-818Article in journal (Refereed)
    Abstract [en]

    Background: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. Methods: Patients (n = 413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. L-alanyl-L-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for greater than3 days were considered as predetermined per protocol (PP) patients. Results: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P = 0.792, for the glutamine group and the controls, respectively. Conclusion: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.

  • 114.
    Wilhelms, SB
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Huss, F
    Uppsala University, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Epidemiological investigations of severe sepsis: a comparison of ICD code abstraction strategies to the ACCP/SCCM consensus criteria2013In: Intensive Care Medicine, 2013Conference paper (Refereed)
  • 115.
    Wilhelms, Susanne B
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Huss, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Granath, Goran
    Uppsala University.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Assessment of incidence of severe sepsis in Sweden using different ways of abstracting International Classification of Diseases codes: Difficulties with methods and interpretation of results2010In: CRITICAL CARE MEDICINE, ISSN 0090-3493, Vol. 38, no 6, p. 1442-1449Article in journal (Refereed)
    Abstract [en]

    Objective: To compare three International Classification of Diseases code abstraction strategies that have previously been reported to mirror severe sepsis by examining retrospective Swedish national data from 1987 to 2005 inclusive. Design: Retrospective cohort study. Setting: Swedish hospital discharge database. Patients: All hospital admissions during the period 1987 to 2005 were extracted and these patients were screened for severe sepsis using the three International Classification of Diseases code abstraction strategies, which were adapted for the Swedish version of the International Classification of Diseases. Two code abstraction strategies included both International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, whereas one included International Classification of Diseases, Tenth Revision codes alone. Interventions: None. Measurements and Main Results: The three International Classification of Diseases code abstraction strategies identified 37,990, 27,655, and 12,512 patients, respectively, with severe sepsis. The incidence increased over the years, reaching 0.35 per 1000, 0.43 per 1000, and 0.13 per 1000 inhabitants, respectively. During the International Classification of Diseases, Ninth Revision period, we found 17,096 unique patients and of these, only 2789 patients (16%) met two of the code abstraction strategy lists and 14,307 (84%) met one list. The International Classification of Diseases, Tenth Revision period included 46,979 unique patients, of whom 8% met the criteria of all three International Classification of Diseases code abstraction strategies, 7% met two, and 84% met one only. Conclusions: The three different International Classification of Diseases code abstraction strategies generated three almost separate cohorts of patients with severe sepsis. Thus, the International Classification of Diseases code abstraction strategies for recording severe sepsis in use today provides an unsatisfactory way of estimating the true incidence of severe sepsis. Further studies relating International Classification of Diseases code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine scores are needed.

  • 116.
    Willebrand, Mimmie
    et al.
    Uppsala University.
    Sveen, Josefin
    Uppsala University.
    Ramklint, M.D. Mia
    Uppsala University.
    Bergquist, R.N. Maria
    University of Uppsala Hospital.
    Huss, M.D. Fredrik
    Uppsala University.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Psychological problems in children with burns-Parents reports on the Strengths and Difficulties Questionnaire2011In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, no 8, p. 1309-1316Article in journal (Refereed)
    Abstract [en]

    Burns may have a devastating effect on psychological health among children, although previous studies report difficulties as well as positive findings. The aims were to describe the rate of psychological problems in children with burns using a standardised instrument and to explore statistical predictors of these problems. Parents (n = 94) of children aged 3-18 years who sustained burns 0.3-9.0 years previously answered the Strengths and Difficulties Questionnaire (SDQ) covering Emotional symptoms, Conduct problems, Hyperactivity/Inattention, Peer relationship problems, Prosocial behaviour, and a Total difficulties score. Questions regarding parental psychological health and family situation were also included. The results for three of the SDQ subscales were close to the norm (10%) regarding the rate of cases where clinical problems were indicated, while the rate of cases indicated for Conduct, Peer problems and Total difficulties was 18-20%. Statistical predictors of the SDQ subscales were mainly parents psychological symptoms, fathers education, and changes in living arrangements. Visible scars were relevant for the Total difficulties score and Hyperactivity/Inattention. In summary, a slightly larger proportion of children with burns had psychological problems than is the case among children in general, and family variables exerted the most influence on parental reports of childrens psychological problems.

  • 117.
    Zhang, Jianjun
    et al.
    Tongji University, Peoples R China .
    Tang, Ou
    Linköping University, Department of Management and Engineering, Production Economics. Linköping University, The Institute of Technology. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Zhao, Jin
    Tongji University, Peoples R China .
    Huo, Jiazhen
    Tongji University, Peoples R China .
    Xia, Yonggang
    China Postal Express and Logist Corp, Peoples R China .
    CPEL Redesigns Its Land Express Network2013In: Interfaces, ISSN 0092-2102, E-ISSN 1526-551X, Vol. 43, no 3, p. 221-231Article in journal (Refereed)
    Abstract [en]

    The China Postal Express and Logistics Corporation (CPEL), Chinas largest corporation in the express delivery industry, is restructuring its nationwide land express network after completing its reorganization. In this redesign project, we proposed a network design framework and developed a decision support system (MMHHSNDDSS) to integrate and optimize the topology structure and functional configuration of CPELs intermodal and multilayered network. Our model seeks to minimize operations and investment costs, constrained by the delivery time limits of CPELs service products. Using MMHHSNDDSS, CPELs senior management team can determine the optimal network by incorporating soft constraints, such as the experience of CPELs decision makers, into a series of solutions. According to an evaluation based on data gathered in 2009, CPEL expects the new network to improve service levels and provide savings of more than 20 percent in annual operations costs. The implementation of our proposed solution began in 2010. In addition, the quantitative methods applied in this project have changed the companys attitude toward applying operations research methods to strategic decision-making processes.

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