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  • 201.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study2002Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, nr 5, s. 279-283Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The distribution of sitting pressure and ability to respond with reactive hyperaemia were studied in a group of paraplegic and tetraplegic patients (n = 8) with spinal cord lesions and healthy controls (n = 10) using a pressure sensitive plate and laser Doppler perfusion imager. The results show that the mean sitting pressure of the patients was 9.9 N/cm2 (left) and 11.7 N/cm2 (right) compared with 3.5 N/cm2 (left) and 3.6 N/cm2 (right) in controls. The differences were significant on both the left (p < 0.01) and right (p < 0.05) sides. The maximum pressure in patients was 42.9 N/cm2 (left) and 48.7 N/cm2 (right), and in controls 12.0 N/cm2 (left) and 12.9 (right) (p < 0.01). Both groups showed a reduction in skin perfusion in the seat area during sitting compared with unloaded resting, and in the controls it was significantly increased (p < 0.001 on both sides) during the reactive hyperaemic phase immediately after sitting. Compared with the preload values, the patients showed a similar but slightly weaker picture significant on the right side (p < 0.05), but not on the left. The hyperaemia was not uniformly distributed, but occurred where the pressure was greater than 2 N/cm2. There was no correlation between the amount of reactive hyperaemia and absolute values of sitting pressures. We conclude that tetraplegic and paraplegic patients have significantly higher sitting pressures than normal controls, and that the hyperaemic response in the buttock region in the upright position after pressure load is slightly weaker in the patients, which could be of importance for the development of decubitus ulcers.

  • 202.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöstrand, Lotta
    Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load2006Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 40, nr 3, s. 153-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In patients with spinal cord injuries (n=8) and healthy controls (n=8) the hyperaemic response in the buttock skin after sitting on a hard surface was studied using a laser Doppler perfusion imager. They sat for three minutes (short load), or 15 minutes (long load). An exponential mathematical function was used to compare the mean perfusion during the observed interval. The results showed that preloading perfusion is significantly higher among patients than healthy subjects. In both groups, the microcirculation of the skin increased significantly after loading, and peak perfusion was significantly lower after the short load. The mean perfusion was higher among the patients after both loadings, which suggests that there was stronger ischaemic provocation. The main outcome was that there was a dose-response relation between duration of loading and intensity of reactive hyperaemia, and that patients with spinal cord injuries have greater perfusion before and after loading than healthy controls.

  • 203.
    Tokarik, Monika
    et al.
    Charles University of Prague, Czech Republic .
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    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 LiDCO2013Inngår i: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 34, nr 5, s. 537-542Artikkel i tidsskrift (Fagfellevurdert)
    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)

  • 204.
    Tokarik, Monika
    et al.
    Charles University of Prague, Czech Republic .
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    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 burns2013Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, nr 2, s. 243-248Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 205.
    Tyden, Jonas
    et al.
    Ostersund Hospital, Sweden; Umeå University, Sweden.
    Herwald, Heiko
    Lund University, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Johansson, Joakim
    Ostersund Hospital, Sweden; Umeå University, Sweden.
    Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 3, s. e0152035-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure. Methods This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days. Results Median SAPS 3 was 58.8 (48-70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p&lt;0.001) as well as with circulatory failure (p&lt;0.001), after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality. Conclusions A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population its predictive value at the individual patient level is low.

  • 206.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Willebrand, Mimmie
    Uppsala University, Sweden .
    The Burn Specific Health Scale-Brief: Measurement invariant across European countries2013Inngår i: JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, ISSN 2163-0755, Vol. 74, nr 5, s. 1321-1326Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 207.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Winso, O.
    Norrland University Hospital.
    Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients2011Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, nr 7, s. 812-818Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 208.
    Wilhelms, SB
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Hälsouniversitetet.
    Huss, F
    Uppsala University, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Epidemiological investigations of severe sepsis: a comparison of ICD code abstraction strategies to the ACCP/SCCM consensus criteria2013Inngår i: Intensive Care Medicine, 2013Konferansepaper (Fagfellevurdert)
  • 209.
    Wilhelms, Susanne B
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Huss, Fredrik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Granath, Goran
    Uppsala University.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Assessment of incidence of severe sepsis in Sweden using different ways of abstracting International Classification of Diseases codes: Difficulties with methods and interpretation of results2010Inngår i: CRITICAL CARE MEDICINE, ISSN 0090-3493, Vol. 38, nr 6, s. 1442-1449Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 210.
    Wilhelms, Susanne
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Walther, Sten
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Huss, F.
    Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Severe sepsis in the ICU is often missing in hospital discharge codes.2017Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients.

    METHODS: All patients (≥ 18 years of age) with severe sepsis according to the ACCP/SCCM criteria registered in the Swedish Intensive Care Registry (2005-2009) were included in the study. Using the Swedish National Patient Register, we investigated whether these patients fulfilled an ICD code compilation for severe sepsis at hospital discharge.

    RESULTS: Overall, 9271 patients with severe sepsis were registered in the Swedish Intensive Care Registry. A majority of these patients (55.4%) were discharged from the hospital with ICD codes that did not correspond to any of the ICD code compilations. A minority of patients (10.3%) were discharged with ICD codes corresponding to all three code abstraction strategies applied. Overall, the proportion of patients discharged with ICD codes corresponding to the criteria of Angus et al. was 15.1%, to the criteria of Flaatten was 39.8%, and to the criteria of Martin et al. was 16.0%.

    CONCLUSIONS: A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.

  • 211.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Psychological problems in children with burns-Parents reports on the Strengths and Difficulties Questionnaire2011Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, nr 8, s. 1309-1316Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 212. Wood, K
    et al.
    Henricson, Joakim
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi.
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Sjöberg, Folke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Assessment of microvascular response in vivo by local warming and the effects of iontophoritically-applied vasoconstrictive drugs2006Rapport (Annet vitenskapelig)
  • 213.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lindahl, Olof Anton
    Department of Applied Physics and Electronics, Umeå University and Biomedical Engineering and Informatics, University Hospital of Northern Sweden, Umeå, Sweden .
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Non-invasive assessment of fluid volume status in the interstitium after haemodialysis2000Inngår i: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, nr 2, s. 211-220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During dialysis excess fluid is removed from uraemic patients. The excess fluid is mainly located in the skin and subcutaneous tissues. In this study we wished, with two non-invasive techniques, the IM (impression method) and BIA (bioimpedance analysis), to study what mechanical (IM) and electrical cellular membrane (BIA) effects the fluid withdrawal has on these tissues. The IM measures the resistive force of the tissues when mechanically compressed. From the force curve two parameters are calculated, the F(0), indicative of interstitial tissue pressure and the FT corresponding to the translocation of tissue fluid (interstitial movable water).

    The BIA phase angle shift (), i.e. geometrical angular transformation of the ratio between reactance and resistance, which has been associated with cellular membrane function, was used as a measurement of electrical cellular membrane effects.

    Twenty patients were studied before and after haemodialysis measuring the F(0), FT and . The results showed that the patients lost a median of 3.7 kg during the haemodialysis. F(0) increased until after dialysis, but did not reach significant values, whereas FT increased significantly after dialysis, p < 0.001, as compared with before. After a peak at one hour postdialysis the FT value returned to predialysis values at four hours after termination of dialysis. Also increased from before to after dialysis, p < 0.001, but already after one hour it returned to predialysis values.

    It is common knowledge that dialysis alters the dynamics of fluid in the interstitium of the skin and subcutis. We conclude that the impression method is sensitive enough to detect and chronicle these changes. Furthermore, with the BIA, (phase angle) signs of changes in the electrical properties of the tissues, possibly reflecting cellular membrane function, could be detected.

  • 214.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lindahl, Olof Anton
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet.
    Ängquist, Karl-Axel
    Department of Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Non-invasive assessment of intercompartmental fluid shifts in burn victims1998Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 24, nr 3, s. 233-240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Two non-invasive methods (the bioimpedance technique, BIA, and the impression method, IM) were studied, to find out whether they are sensitive enough to detect and chronicle the development of the oedema and fluid resuscitation effects (Parkland formula) that occur secondary to a major burn. Ten patients with a total burned body surface area (TBSA) of more than 10% were included in this prospective study. Total body water (TBW), as measured by the resistance (BIA) or F(0) variable (IM), reached a maximum on day 2. The tissue fluid translocation (INT) variable (IM) followed a different course, increasing slowly to reach a maximum on day 6, when it was 40% higher than the 12 h value. TBW and the interstitial translocatable fluid were still increased 1 week post-burn. The non-invasive measurements of TBW (resistance by BIA and F(0) by IM) reflected the anticipated changes in TBW. The phase angle (BIA) indicative of cellular membrane effects of burn and sepsis had its lowest values at day 1.5, and stayed significantly low until day 4. Interestingly, the phase angle was lowest in the two cases that died subsequently. The different time course of the INT value (IM), which reflected the translocatable interstitial fluid volume in skin, may be the result of resuscitation fluid remaining in this compartment, due to the excess sodium content together with a possible change in tissue compliance secondary to the early total water peak on day 2.

  • 215.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lisander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Jones, Wayne A.
    The National Laboratory of Forensic Chemistry, University Hospital, Linköping, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans2001Inngår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, nr 5, s. 844-852Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.

    Design: Consecutive patients (matched groups) and healthy controls.

    Setting: National burn unit in a Swedish university hospital.

    Patients and subjects: Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.

    Interventions: The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.

    Measurements and results: Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.

    Conclusion: Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.

  • 216.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lisander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Jones, Wayne A.
    National Laboratory of Forensic Chemistry, Linköping, Sweden.
    The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver1999Inngår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 27, nr 12, s. 2622-2625Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To study the rate of elimination of ethanol after a major burn trauma.

    Design: Prospective, controlled study.

    Setting: National burns unit in a Swedish university hospital.

    Patients and Subjects: Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects.

    Interventions: The patients received ethanol, 0.35-0.60 g/kg body weight intravenously, during 1 hr. This was repeated daily during the first week postburn. The control subjects received the same amount of ethanol once.

    Measurements and Main Results: Blood samples were drawn at 20- to 30-min intervals during 5 hrs after the start of the infusion. Serum ethanol was determined by headspace gas chromatography. The rate of elimination of ethanol was calculated from the concentration time profile. In the control subjects, the median elimination rate was 0.074 g/kg/hr (range, 0.059-0.083 g/kg/hr). In the patients, it was already 0.138 g/kg/hr (range, 0.111-0.201 g/kg/hr) on the first day; this increased even further over the following 6 days, reaching 0.183 g/kg/hr (range, 0.150-0.218 g/kg/hr) on the seventh day.

    Conclusions: Ethanol elimination is augmented postburn. A more effective reoxidation of reduced nicotinamide adenine dinucleotide seems the most likely explanation for the increased rate of ethanol elimination in these hypermetabolic trauma patients. This finding suggests that the oxidative capacity of the liver may be assessed by studying the rate of ethanol elimination in burn victims.

  • 217. Åkerlund, Emma
    et al.
    Erlandsson, Ulf
    Sjöberg, Folke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Huss, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Brännskador: Antalet skadade och avlidna sjunker kontinuerligt men äldre utgör fortsatt en riskgrupp2007Inngår i: Nordisk geriatrik, ISSN 1403-2082, Vol. 10, nr 3Artikkel i tidsskrift (Fagfellevurdert)
  • 218. Åkerlund, Emma
    et al.
    Huss, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Sjöberg, Folke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Burns in Sweden: An analysis of 24 538 cases during the period 1987-20042007Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 33, nr 1, s. 31-36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Burn care is always progressing, but there is little epidemiological information giving a clear picture of the current number of treated burns in Sweden. This study was conducted to provide an update of patients admitted to hospital with burns in Sweden. Data were obtained for all patients who were admitted to hospitals with a primary or secondary diagnosis of burns (ICD-9/10 codes) from 1 January 1987 to 31 December 2004, 24 538 patients were found. Most of the patients were male (69%), giving a male:female ratio of 2.23:1. Children in the age-group 0-4 years old predominated, and accounted for 27% of the study material. The median length of stay was 3 days. Throughout the period 740 patients (3%) died of their burns. Significant reductions in mortality, incidence, and length of stay were seen during the study, which correlates well with other studies. However, most of the reductions were in the younger age-groups. Men accounted for the improved mortality, as female mortality did not change significantly. We think that the improvement in results among patients admitted to hospital after burns is a combination of preventive measures, improved treatment protocols, and an expanding strategy by which burned patients are treated as outpatients. © 2006 Elsevier Ltd and ISBI.

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