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  • 26751.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting. Department of Otolaryngology, University Hospital, Linkoping, Sweden.
    Fredrickson, John
    University of Toronto, Canada.
    Larsby, Birgitta
    Linköpings universitet. Department of Otolaryngology, University Hospital, Linkoping, Sweden.
    Projection of the vestibular nerve to the SI arm field in the cerebral cortex of the cat1975Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 79, nr 1-2, s. 88-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Evoked cortical focal potentials from electrical vestibular nerve stimulation were recorded in the Pcd-area in cats anaesthetized with Chloralose or Nembutal. For comparison, additional cortical projections were located for n. rad. superficialis and group Ia muscle afferents from n. rad. prof., n. fibularis prof., n. femuralis ramus muscularis and the motor nerve to the trapezoid muscle. Surface positive potentials, which reversed to negativity in middle cortical layers, were for vestibular nerve stimulation recorded in the S I forelimb field in a small area close to Pcd in the posterior medial part of the deep radial nerve projection field. The location of this field is compared with the vestibulo-cortical projections described earlier for rodents, squirrel monkey, and rhesus monkey. The histology shows that the field was within the cytoarchitectonic 3a area.

  • 26752.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Gripmark, M.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Ledin, Torbjörn
    Östergötlands Läns Landsting.
    The subjective horizontal in eccentric rotation influenced by peripheral vestibular lesion1996Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 116, nr 2, s. 181-184Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed with caloric irrigation, and sometimes falsely been interpreted as a vestibular nerve lesion. the vertical semicircular canals are not easily assessed. Caloric testing with the head in different positions is not very helpful, but the canals may pairwise be tested using specific rotational techniques. Often the otolithic organs, capable of detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. We have implemented horizontal rotatory testing with the subject seated eccentrically facing the direction of rotation as a means of assessing otolithic function. the subject experiences a lateral tilt and is instructed in darkness to put a short light bar in the position he thinks a water surface would have, which is identical to his perceived tilt. in 39 normal subjects, a theoretical tilt of 24° was estimated as approximately 19.5°, and the standard deviation was 6°. A side difference index was proposed to be normal if below 25%. the preliminary findings in a few patients with known labyrinthine lesions are presented. We propose that otolithic as well as lateral semicircular canal functions are useful to monitor in patients with suspected peripheral equilibrium disorders.

  • 26753.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Andersson, Hans
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet.
    The visual suppression test1983Inngår i: Proc NES 1983, 1983Konferansepaper (Annet vitenskapelig)
  • 26754.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Jerlvall, T.
    Andersson, Hans
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    A computerized saccade test - clinical value1983Inngår i: Proc NES 1983, 1983, s. 202-208Konferansepaper (Annet vitenskapelig)
  • 26755.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Hydén, Dag
    Linköpings universitet.
    Rotatory tests1993Inngår i: NES 1993, 1993Konferansepaper (Annet vitenskapelig)
  • 26756.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Aschan, Gunnar
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Influence of industrial solvents on the balance system1977Inngår i: International symposium on the control of air pollution in the working environment, 1977, 1977, s. 80-87Konferansepaper (Annet vitenskapelig)
  • 26757.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Ledin, Torbjörn
    Linköpings universitet. Östergötlands Läns Landsting.
    Eccentric rotation as a means to assess otolith function: normal subjects and findings in unilateral Menieres Disease1996Konferansepaper (Annet vitenskapelig)
  • 26758.
    Ödkvist, Lars
    et al.
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, Regional-and University Hospital, Linköping University, Linköping, Sweden.
    Larsby, Birgitta
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, Regional-and University Hospital, Linköping University, Linköping, Sweden.
    Liedgren, Christer
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, Regional-and University Hospital, Linköping University, Linköping, Sweden.
    Fredrickson, John
    University of Toronto, Canada.
    Tham, Richard
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, Regional-and University Hospital, Linköping University, Linköping, Sweden.
    Vestibular and oculomotor disturbances caused by industrial solvents1980Inngår i: Journal of Otolaryngology, ISSN 0381-6605, Vol. 9, nr 1, s. 53-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hydrocarbon solvents, xylene, styrene, methylchloroform, and trichlorethylene, given intravenously to rabbits produce a positional nystagmus. Due to their additional influence on rotatory nystagmus, one may conclude that their mode of action takes place in the central nervous system. Optokinetic (OKN) responses in rabbits, cats, and humans were also influenced by styrene. OKN responses have not yet been tested for the other solvents. A comparison is made with the effects of alpha-chloralose and the GABA-antagonists bicuculline and picrotoxin which produced similar disturbances. The GABA agonist, baclofen, prevents positional induced styrene nystagmus. It seems likely therefore that the solvents may act by blocking the cerebellar inhibition of vestibulo-oculomotor reflexes. Solvents given simultaneously in some combinations are either

  • 26759.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Tham, Richard
    Linköpings universitet.
    Disturbancies of the oculomotor system caused byhydrocarbon solvents1981Inngår i: Functional basis of Ocular Motility Disorders, 1981, 1981, s. 535-536Konferansepaper (Annet vitenskapelig)
  • 26760.
    Ödkvist, Lars
    et al.
    Linköpings universitet. Department of Otolaryngology and Department of Clinical Pharmacology, Regional and University Hospital, Linköping University, Linköping, Sweden.
    Larsby, Birgitta
    Linköpings universitet. Department of Otolaryngology and Department of Clinical Pharmacology, Regional and University Hospital, Linköping University, Linköping, Sweden.
    Tham, Richard
    Linköpings universitet. Department of Otolaryngology and Department of Clinical Pharmacology, Regional and University Hospital, Linköping University, Linköping, Sweden.
    Aschan, Gunnar
    Linköpings universitet. Department of Otolaryngology and Department of Clinical Pharmacology, Regional and University Hospital, Linköping University, Linköping, Sweden .
    On the mechanisms of vestibular disturbancies caused by industrial solvents1979Inngår i: Advances in Oto-Rhino-Laryngology, ISSN 0065-3071, E-ISSN 1662-2847, Vol. 25, s. 167-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The industrial solvents xylene, styrene, trichloroethylene and methylchloroform administered to rabbits caused a positional nystagmus and disturbances in the nystagmus response to rotatory acceleration. The positional nystagmus had a beat direction the opposite to positional alcohol nystagmus, which was in similar experiments elicited by methanol, ethanol and propanol. The three alcohols needed a ten times higher blood concentration to cause a nystagmus than the solvents did.

  • 26761.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Vestibular oculomotor dysfunction caused by solvents1982Inngår i: Nordic symposium on data processing of eye movements 1982, 1982Konferansepaper (Annet vitenskapelig)
  • 26762.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Vestibulo-oculomotor disturbances caused by industrial solvents1983Inngår i: Otolaryngology - Head and Neck Surgery, ISSN 0194-5998, Vol. 91, nr 5, s. 537-539Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Animal experiments show that intoxication with hydrocarbon solvents influences the vestibulo-oculomotor reflex arc and indicate that the solvents block the inhibition of the vestibulo-oculomotor reflex presumably exerted by the cerebellum. The blood concentrations necessary to elicit oculomotor disturbances in animals were smaller than those that disturbed the vestibular function. Accordingly, in human experiments styrene and toluene exposure did not elicit any positional nystagmus but caused an increased saccade speed and a diminished visual suppression of vestibular nystagmus. Some cerebellar clinical pathologic process in patients who suffer from a psycho-organic syndrome caused by solvents leads us to believe that the cerebellum might be the most vulnerable part of the brain. Some patients had a positional nystagmus, but the most prominent pathologic signs were elicited by the visual suppression test. Our findings compare well with the increased saccade speed and diminished visual suppression in patients with cerebellar tumors and infarctions

  • 26763.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Aschan, Gunnar
    Linköpings universitet.
    Positional nystagmus elicited by industrial solvents1978Inngår i: Vestibular mechanisms in health and disease, 1978 / [ed] Hood JD, Academic Press, 1978, s. 18-27Konferansepaper (Annet vitenskapelig)
  • 26764.
    Ödkvist, Lars
    et al.
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden .
    Larsby, Birgitta
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Tham, Richard
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Åhlfeldt, H.
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Andersson, Björn
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Eriksson, Birgitta
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Liedgren, Christer
    Linköpings universitet. Departments of Otolaryngology and Clinical Pharmacology, University Hospital, Linköping, Sweden.
    Vestibulo-oculomotor disturbances in humans exposed to styrene1982Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 94, nr 1-6, s. 487-493Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Several reports indicate that disturbances of the vestibulo-oculomotor ability are a manifestation of the toxic action on the central nervous system exerted by some industrial solvents. The aim of the present investigation was to examine the vestibulo-oculomotor system during exposure to styrene, which is extensively used in the production of plastics. Healthy volunteers were exposed to styrene for one hour. Rotatory and optokinetic nystagmus, visual suppression as well as speed, latency and accuracy of saccades were tested before, during, and one hour after the exposure. The pulmonary uptake and the blood level of the solvent were continuously analysed by gas chromatography. The styrene blood concentration was equivalent to that which may well be reached after several hours of hard work in an industrial environment with a concentration of styrene within permitted limits. No spontaneous nystagmus appeared. The rotatory and optokinetic nystagmus was not influenced by styrene. However, the speed of the saccade was significantly enhanced. The visual suppression was disturbed, shown by an increased gain after styrene exposure. The experiments thus indicate that styrene given to healthy test persons induced disturbances, thus consistent with the theory that some organic solvents block the cerebellar inhibition of the vestibulo-oculomotor system.

  • 26765.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Ledin, Torbjörn
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Gripmark, M.
    Noaksson, Lisbeth
    Östergötlands Läns Landsting.
    Olsson, S.
    Östergötlands Läns Landsting.
    Otolithic tests in Menière’s disease1995Inngår i: Ménièr's Disease, 1995 / [ed] Vesterhauge S, Katholm M, Mikines P, 1995, s. 259-265Konferansepaper (Annet vitenskapelig)
  • 26766.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Östergötlands Läns Landsting.
    Jerlvall, L.
    Östergötlands Läns Landsting.
    Vestibular and somatosensory inflow to the vestibular projection area in the post cruciate dimple region of the gat cerebral cortex1975Inngår i: Experimental Brain Research, ISSN 0014-4819, E-ISSN 1432-1106, Vol. 22, nr 2, s. 185-196Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In anesthetized cats 251 cells within the cortical vestibular projection area, adjacent to the post-cruciate dimple, were analyzed as to their input characteristics employing extracellular recording techniques. The post cruciate dimple vestibular field, which is located in area 3a, has a high degree of convergence between vestibular and peripheral somatosensory input. The latter is not restricted to muscle afferents but includes cutaneous modalities. The functional significance of this vestibular cortical projection field is discussed.

  • 26767.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Möller, C.
    Linköpings universitet.
    Thell, Jan
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Gentamycin-treated Meniere's disease evaluated by rotatory tests1985Inngår i: Myers E, editor.; Elsevier SiencePublishers B.V.; 1985 / [ed] Myers E,, 1985, s. 43-44Konferansepaper (Annet vitenskapelig)
  • 26768.
    Ödkvist, Lars
    et al.
    Östergötlands Läns Landsting.
    Möller, Claes
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Vestibulr Compensation Measured by the Broad-Frequency Band Rotatory Test1987Inngår i: The Vestibular system: Neurophysiologic and clinical research / [ed] Malcolm D. Graham, John L. Kemink, New York: Raven Press , 1987, s. 287-291Konferansepaper (Fagfellevurdert)
  • 26769.
    Ödkvist, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Noaksson, L M
    Greibe, Patrick
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Ledin, Torbjörn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Neurootology in neck trauma patients2004Inngår i: Bárány Society XXIII International Congress,2004, 2004, s. 156-156Konferansepaper (Annet vitenskapelig)
  • 26770.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Hydén, Dag
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Edling, Christer
    Bergholtz, Lars
    Östergötlands Läns Landsting.
    Tidig diagnostik vid lösningsmedelsskada1982Inngår i: Sv Otolaryngol förening 1982;2, 1982, s. 2-Konferansepaper (Annet vitenskapelig)
  • 26771.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Aschan, Gunnar
    Linköpings universitet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Hur inverkar industriella lösningsmedel på balansapparaten1978Inngår i: Läkaresällskapets riksstämma 1978, 1978Konferansepaper (Annet vitenskapelig)
  • 26772.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Tham, Richard
    Linköpings universitet.
    Åhlfeldt, H.
    Linköpings universitet.
    Andersson, Björn
    Linköpings universitet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet.
    Vestibulo-oculomotor findings during styrene exposure1981Inngår i: World Congress of Otolaryngol 1981, 1981Konferansepaper (Annet vitenskapelig)
  • 26773.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Thell, Jan
    Östergötlands Läns Landsting.
    Hydén, Dag
    Linköpings universitet.
    Larsby, Birgitta
    Linköpings universitet.
    Vascular cause for vertigo1986Inngår i: Claussen C-F, Kirtane MV, editors. Vertigo, nausea,tinnitus and hearing loss in cardiovasculr disease.: Elsevier SciencePublishers B.V.; 1986, 1986, s. 61-68Konferansepaper (Annet vitenskapelig)
  • 26774.
    Ödkvist, Lars
    et al.
    Linköpings universitet. Department of Otolaryngology, University Hospital, Linköping, Sweden..
    Thell, Jan
    Östergötlands Läns Landsting. Department of Otolaryngology, University Hospital, Linköping, Sweden..
    Larsby, Birgitta
    Linköpings universitet. Department of Otolaryngology, University Hospital, Linköping, Sweden..
    A comparison between smooth pursuit and visual suppression1988Inngår i: Advances in Oto-Rhino-Laryngology, ISSN 0065-3071, E-ISSN 1662-2847, Vol. 41, s. 109-115Artikkel i tidsskrift (Fagfellevurdert)
  • 26775.
    Ödkvist, Lars
    et al.
    Linköpings universitet.
    Åstrand, I.
    Arbetsmiljöinstitutet.
    Larsby, Birgitta
    Linköpings universitet.
    Käll, K.
    Arbetsmiljöinstitutet.
    Ger lösningsmedel störningar i vestibulo-oculomotorsystemet ?1980Inngår i: Arbete och Hälsa, ISSN 0346-7821, Vol. 2, nr 1Artikkel i tidsskrift (Annet vitenskapelig)
  • 26776.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Technology in rotatory testing. 18th Bárány Society Meeting in Uppsala, June 6-8,1994.1994Inngår i: 18th Bárány Society Meeting in Uppsala, June 6-8,1994., 1994Konferansepaper (Annet vitenskapelig)
  • 26777.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Influence of industrial solvents on the vestibular system.1978Inngår i: World congress on otolaryngology 1978, Miami Beach, 1978, s. 275-Konferansepaper (Annet vitenskapelig)
  • 26778.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Nackafferenter and vestibularis. Sv Otolaryngol förening 1995;1:45-46.1995Inngår i: Sv Otolaryngol förening 1995, 1995, s. 45-46Konferansepaper (Annet vitenskapelig)
  • 26779.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Liedgren, Christer
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Integration mellan proprioception och N.Vestibularis i CNS.1974Inngår i: Läkaresällskapets riksstämma 1974., 1974Konferansepaper (Annet vitenskapelig)
  • 26780.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Thell, Jan
    Östergötlands Läns Landsting.
    Bengtsson, Ann
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Vertigo in fibromyalgi1986Inngår i: In: Claussen C-F, Kirtane MV, editors. Vertigo,nausea, tinnitus and hearing loss in cardiovascular diseases.: Elsevier SciencePublishers B.V. 1986 / [ed] Claussen C-F, Kirtane MV, 1986, s. 429-433Konferansepaper (Annet vitenskapelig)
  • 26781.
    Ödkvist, LM
    et al.
    Östergötlands Läns Landsting.
    Thell, Jan
    Östergötlands Läns Landsting.
    Larsby, Birgitta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    A Comparison between Smooth Pursuit and Visual Suppression1988Inngår i: In Adv. Oto-Rhino-Laryng. Vol 41, 109-115. / [ed] Pirodda E, Pompeiano O., 1988, s. 109-115Konferansepaper (Fagfellevurdert)
  • 26782. Bestill onlineKjøp publikasjonen >>
    Ödman, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Intensive training in group for children with Cerebral Palsy: Evaluation from different perspectives2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    There is a need of more evidence‐based knowledge of different treatment/training‐approaches for children with Cerebral Palsy (CP) to better describe the objectives of interventions, effects on functioning and fulfilment of health care needs. The general aim of this thesis was to evaluate the effectiveness of intensive training in groups (ITGs) with a habilitation approach and a conductive education approach. In addition, this thesis explored different meanings of participation in ITGs to parents from a parent perspective. This thesis consists of two parts, a quantitative evaluation of the effectiveness of two ITGs (paper I‐III) and a qualitative study exploring parents’ different ways of experiencing ITGs (paper IV). Fifty‐four children, 3‐16 years old, with different types of CP, intellectual capacity and level of gross motor function, participated with their parents in a four weeks ITG with a short‐term and a one‐year follow‐up (paper I‐III). The second sample was strategically composed of parents to 15 children with CP with experiences of ITGs in different settings.

    The results showed that the proportion of clinically significant change in gross motor capability, functional skills or self‐reported individualized goal measure didn’t show any major differences between the two ITGs. One period of ITG facilitated small clinical and parent reported improvements in functioning for the short‐term. Nine children out of 54 made a clinically significant improvement in gross motor capability (GMFM‐88 total score); 36 children improved if an improvement in any dimension A‐E was counted for. Twenty‐two children out of 52 improved in one of the domains self‐care, mobility and social function (PEDI Functional Skills). Twenty‐eight parents out of 54 perceived a clinically significant improvement on the self‐reported individualized goal measure. Most individualized goals dealt with motor activities and movement‐related body functions in both ITGs. The self‐reported individualized goal measure was not found to be more sensitive to change than the clinical measures.

    The one‐year follow‐up showed that children had a stable level of functioning. No child deteriorated on the clinical measures short‐term and at the one‐year follow‐up. A higher proportion of change was seen in the social function domain at the one‐year follow‐up, indicating a better potential to change in social function than in gross motor function. The majority of children had a high consumption of training delivered by the Child and Youth Habilitation and merely half of the group continued with repeated ITGs. The differences in functional outcome between children continuing with repeated ITGs compared with only customary Child and Youth Habilitation were limited to a higher proportion of improvements in social functioning.

    Parents perceived a high service quality in both ITGs. To parents, fulfilment of health care needs was as important as functional outcome. The probability for high service quality was associated with previous experience of the ITG, high expectations of improvements, if expectations and improvements in gross motor capability were achieved and if the child participated in the ITG with the habilitation approach. Therapists in the habilitation approach were more involved in discussions with parents about expectations for the ITG and knowledge exchange than conductors were, indicating more familycenteredness.

    The qualitative study points to a variety of parental needs that may be met at ITGs but also indicates some problems that should be addressed. Five overarching meaning categories of ITGs were described: ITGs as knowledge promotion, as a complementary training resource, as a bracket to ordinary life, as building up relations with therapists, and as a leisure‐activity. An additional category – “ITGs as risk for ill‐being” – subsumed different kinds of problems that may arise. Conceptions suggest that ITGs contribute to parents’ improved knowledge, support and well‐being, but ITGs could also negatively influence family‐functioning.

    Professionals and parents need to discuss parents’ previous experiences of ITGs, expectations of functional improvements, the functioning of the child and health care needs in order to individualize goals for ITGs and make the objectives for participation clear. There were no major differences in effectiveness between the two ITGs, a habilitation approach and conductive education approach. Various training approaches should be chosen depending on the child’s and family’s needs. In the choice between different training approaches it is of equal importance to acknowledge functional needs of the child as well as health care needs of the child and parent.

    Delarbeid
    1. Effectiveness of intensive training for children with Cerebral Palsy: a comparison between child and youth rehabilitation and conductive education
    Åpne denne publikasjonen i ny fane eller vindu >>Effectiveness of intensive training for children with Cerebral Palsy: a comparison between child and youth rehabilitation and conductive education
    2005 (engelsk)Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 4, s. 263-270Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objectives: To compare the short-term effectiveness of 1 intensive training period in child and youth rehabilitation with Move&Walk conductive education and describe the effects of 1 intensive training period in terms of changes at 1 year. The amount and influence of additional consumption of training during the 1-year follow-up was also analysed.

    Design: Quasi-experimental with 2 groups: Lemo (n=23) and Move&Walk (n=29).

    Patients: A total of 52 children with cerebral palsy, age range 3–16 years.

    Methods: Data included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory–Functional Skills (PEDI-FS). Data on additional consumption of training was collected at the 1-year follow-up.

    Results: There was no difference in proportion of change on the clinical measures between the training programmes, except for a higher proportion of improvement on the GMFM total score in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of children who participated in repeated intensive training periods showed improved social functioning.

    Conclusion: No major differences were shown between the 2 training programmes. One intensive training period facilitated small improvements in gross motor function. The majority of children had a high consumption of training during the 1-year follow-up and the added value of repeated intensive training periods was limited.

    Emneord
    evaluation studies, exercise therapy, cerebral palsy, treatment outcome
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-12946 (URN)10.1080/16501970510032622 (DOI)
    Tilgjengelig fra: 2008-02-13 Laget: 2008-02-13 Sist oppdatert: 2017-12-13
    2. Effectiveness and expectations of intensive training: a comparison between child and youth habilitation and conductive education
    Åpne denne publikasjonen i ny fane eller vindu >>Effectiveness and expectations of intensive training: a comparison between child and youth habilitation and conductive education
    2006 (engelsk)Inngår i: Disability and Rehabilitation, ISSN 0963-8288, Vol. 28, nr 9, s. 561-570Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective. To compare the effectiveness of two intensive training-programmes from a professional and parent perspective. To describe and compare the type of expectations of the two intensive training programmes with the self-reported individualized goals.

    Design. Quasi-experimental with two groups.

    Setting and intervention. Traditional health care and conductive education.

    Patients and their parents. Fifty-four children with cerebral palsy, 3-16 years old.

    Methods. Data included a self-reported individualized goal measure (SRIGM), before and after the ITP. Individualized goals were classified according to the International Classification of Functioning (ICF). Clinical measures (CM) included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory—Functional Skills (PEDI-FS).

    Results. Twenty-eight parents out of 54 perceived a clinically significant improvement on the SRIGM with no significant difference between the training programmes. Most individualized goals were formulated in the domain of Mobility (115 out of 248) and Neuromusculoskeletal and movement-related functions (64 out of 248 goals) of ICF in both training programmes. There was no difference in the proportion of improvement measured with SRIGM compared to the CM, if an improvement in any dimension in GMFM or domain in PEDI FS was counted.

    Conclusion. There were no major differences in outcome and expectations between the training programmes. Parents' expectations were mainly directed towards improvement in prerequisites of motor function and mobility skills. The SRIGM confirmed the outcome on the CM.

    Emneord
    Evaluation studies; exercise therapy; cerebral palsy; treatment outcome and goals
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-12947 (URN)10.1080/00222930500218821 (DOI)
    Tilgjengelig fra: 2008-02-13 Laget: 2008-02-13 Sist oppdatert: 2009-06-09
    3. Parents´ perception of the quality of two intensive training programmes for children with Cerebral Palsy
    Åpne denne publikasjonen i ny fane eller vindu >>Parents´ perception of the quality of two intensive training programmes for children with Cerebral Palsy
    2007 (engelsk)Inngår i: Developmental Medicine and Child Neurology, ISSN 0012-1622, Vol. 49, nr 2, s. 93-100Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    This study explored parents' perceptions of the service quality of two intensive training programmes and the association between perceived service quality and predefined influential factors. Parents of 31 males and 19 females with spastic, dyskinetic, and ataxic cerebral palsy (mean age 8y 7mo [SD 3y 7mo]; range 3–16y), and Gross Motor Function Classification System Level I n=1; Level II n=9; Level III n=8; Level IV n=20; and Level V n=12 were included. Functional outcome had been evaluated previously with the clinical measures Gross Motor Function Measure-88, the Pediatric Evaluation of Disability Inventory -Functional Skills, and the Self-reported Individualized Goal Measure, before and after a 4-week intensive training period (ITP). The two training programmes used were Lemo and Move&Walk. After the ITP, a telephone interview was performed with the same cohort, using the Patient perspective On Care and Rehabilitation process. Data on previous experiences, expectations, and severity of disability were collected before the ITP, and data on achieved expectations afterwards. Previous experiences of the training programme, high expectations of improvements, achieved expectations, gross motor capacity improvements, and intensive training at the child and youth rehabilitation centre were associated with increased probability of fulfilment of needs. Severity of disability was associated with decreased probability of fulfilment of needs and functional improvements. Most parents perceived high service quality, and achieved expectations were influenced by high service quality rather than by perceived functional improvements. This suggests that needs other than functional improvements must be explained and acknowledged.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-12948 (URN)10.1111/j.1469-8749.2007.00093.x (DOI)
    Tilgjengelig fra: 2008-02-13 Laget: 2008-02-13 Sist oppdatert: 2009-05-19
    4. Parents conceptions of intensive group training. The case of cerebral palsy
    Åpne denne publikasjonen i ny fane eller vindu >>Parents conceptions of intensive group training. The case of cerebral palsy
    2009 (engelsk)Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, nr 4, s. 293-301Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Purpose. The aim was to explore what wants and needs intensive group training (IGT) fulfil for parents of children with cerebral palsy (CP) and what problems that may arise due to participation. Methods. A phenomenograpical approach was used. Semi-structured interviews were conducted to elicit information about what participation means to parents. Results. Five overarching categories expressing positive functions of IGT were identified: IGT as knowledge promotion, as a complementary training resource, as a bracket to ordinary life, as a means to promote relations with therapists, and as a leisure-activity. One category: IGT as risk for ill-being expresses perceived problems. Each category is in turn divided into a number of subconceptions-13 conceptions of this kind were identified. Conclusions. The conceptions express positive and negative functions of IGT as perceived by parents. These functions in turn can be considered as reflections of basic wants and needs. The results demonstrate that IGT have a potential to contribute to feelings of enhanced care competence among parents, of being supported and of increased strength and vitality. All parents did not have needs of participation in IGT for themselves. There is also a risk that IGT is experienced as an additional burden and may have negative effects on family-functioning.

    Emneord
    Cerebral palsy, therapeutics, qualitative research, conductive education, intensive group training
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-17159 (URN)10.1080/09638280801945709 (DOI)
    Merknad
    This is an electronic version of an article published in:Pia Ödman, Bengt Richt and Birgitta Öberg, Parents’ conceptions of intensive group training. The case of cerebral palsy, 2009, DISABILITY AND REHABILITATION, (31), 4, 293-301.Disability and rehabilitation is available online at informaworld:http://dx.doi.org/10.1080/09638280801945709Copyright: Taylor Francis http://www.informaworld.com/Tilgjengelig fra: 2009-03-12 Laget: 2009-03-07 Sist oppdatert: 2017-12-13bibliografisk kontrollert
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    FULLTEXT01
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    COVER01
  • 26783.
    Ödman, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Parents´ perception of the quality of two intensive training programmes for children with Cerebral Palsy2007Inngår i: Developmental Medicine and Child Neurology, ISSN 0012-1622, Vol. 49, nr 2, s. 93-100Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study explored parents' perceptions of the service quality of two intensive training programmes and the association between perceived service quality and predefined influential factors. Parents of 31 males and 19 females with spastic, dyskinetic, and ataxic cerebral palsy (mean age 8y 7mo [SD 3y 7mo]; range 3–16y), and Gross Motor Function Classification System Level I n=1; Level II n=9; Level III n=8; Level IV n=20; and Level V n=12 were included. Functional outcome had been evaluated previously with the clinical measures Gross Motor Function Measure-88, the Pediatric Evaluation of Disability Inventory -Functional Skills, and the Self-reported Individualized Goal Measure, before and after a 4-week intensive training period (ITP). The two training programmes used were Lemo and Move&Walk. After the ITP, a telephone interview was performed with the same cohort, using the Patient perspective On Care and Rehabilitation process. Data on previous experiences, expectations, and severity of disability were collected before the ITP, and data on achieved expectations afterwards. Previous experiences of the training programme, high expectations of improvements, achieved expectations, gross motor capacity improvements, and intensive training at the child and youth rehabilitation centre were associated with increased probability of fulfilment of needs. Severity of disability was associated with decreased probability of fulfilment of needs and functional improvements. Most parents perceived high service quality, and achieved expectations were influenced by high service quality rather than by perceived functional improvements. This suggests that needs other than functional improvements must be explained and acknowledged.

  • 26784.
    Ödman, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Richt, Bengt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Öberg , Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Parents conceptions of intensive group training. The case of cerebral palsy2009Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, nr 4, s. 293-301Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. The aim was to explore what wants and needs intensive group training (IGT) fulfil for parents of children with cerebral palsy (CP) and what problems that may arise due to participation. Methods. A phenomenograpical approach was used. Semi-structured interviews were conducted to elicit information about what participation means to parents. Results. Five overarching categories expressing positive functions of IGT were identified: IGT as knowledge promotion, as a complementary training resource, as a bracket to ordinary life, as a means to promote relations with therapists, and as a leisure-activity. One category: IGT as risk for ill-being expresses perceived problems. Each category is in turn divided into a number of subconceptions-13 conceptions of this kind were identified. Conclusions. The conceptions express positive and negative functions of IGT as perceived by parents. These functions in turn can be considered as reflections of basic wants and needs. The results demonstrate that IGT have a potential to contribute to feelings of enhanced care competence among parents, of being supported and of increased strength and vitality. All parents did not have needs of participation in IGT for themselves. There is also a risk that IGT is experienced as an additional burden and may have negative effects on family-functioning.

    Fulltekst (pdf)
    FULLTEXT01
  • 26785.
    Ödman, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Effectiveness and expectations of intensive training: a comparison between child and youth habilitation and conductive education2006Inngår i: Disability and Rehabilitation, ISSN 0963-8288, Vol. 28, nr 9, s. 561-570Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To compare the effectiveness of two intensive training-programmes from a professional and parent perspective. To describe and compare the type of expectations of the two intensive training programmes with the self-reported individualized goals.

    Design. Quasi-experimental with two groups.

    Setting and intervention. Traditional health care and conductive education.

    Patients and their parents. Fifty-four children with cerebral palsy, 3-16 years old.

    Methods. Data included a self-reported individualized goal measure (SRIGM), before and after the ITP. Individualized goals were classified according to the International Classification of Functioning (ICF). Clinical measures (CM) included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory—Functional Skills (PEDI-FS).

    Results. Twenty-eight parents out of 54 perceived a clinically significant improvement on the SRIGM with no significant difference between the training programmes. Most individualized goals were formulated in the domain of Mobility (115 out of 248) and Neuromusculoskeletal and movement-related functions (64 out of 248 goals) of ICF in both training programmes. There was no difference in the proportion of improvement measured with SRIGM compared to the CM, if an improvement in any dimension in GMFM or domain in PEDI FS was counted.

    Conclusion. There were no major differences in outcome and expectations between the training programmes. Parents' expectations were mainly directed towards improvement in prerequisites of motor function and mobility skills. The SRIGM confirmed the outcome on the CM.

  • 26786.
    Ödman, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Brigitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Effectiveness of intensive training for children with Cerebral Palsy: a comparison between child and youth rehabilitation and conductive education2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 4, s. 263-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To compare the short-term effectiveness of 1 intensive training period in child and youth rehabilitation with Move&Walk conductive education and describe the effects of 1 intensive training period in terms of changes at 1 year. The amount and influence of additional consumption of training during the 1-year follow-up was also analysed.

    Design: Quasi-experimental with 2 groups: Lemo (n=23) and Move&Walk (n=29).

    Patients: A total of 52 children with cerebral palsy, age range 3–16 years.

    Methods: Data included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory–Functional Skills (PEDI-FS). Data on additional consumption of training was collected at the 1-year follow-up.

    Results: There was no difference in proportion of change on the clinical measures between the training programmes, except for a higher proportion of improvement on the GMFM total score in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of children who participated in repeated intensive training periods showed improved social functioning.

    Conclusion: No major differences were shown between the 2 training programmes. One intensive training period facilitated small improvements in gross motor function. The majority of children had a high consumption of training during the 1-year follow-up and the added value of repeated intensive training periods was limited.

  • 26787.
    Ödman, Svante
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    On biomedical electrode technology: with special reference to long-term properties and movement-induced noise in surface electrodes1980Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of the present investigation was to improve the quality of surface electrode measurements. Long-term properties of commercially available ECG-electrodes were studied by investigating polarization potentials, electrode impedance, adhesion and skin reactions during a period of 7 days. The most stable polarization potentials were obtained for Ag/AgC1-electrodes and stable electrode impedance were obtained for disposable electrodes with stable adhesion and equipped with an electrode capsule. Unchanged adhesion and mechanical strength were shown by disposable electrodes with large self-adhesive collars.

    Movement-induced potentials of streaming potential type were studied in various electrode configurations. The geometric design of the electrode was important for reduction of noise generated by the movement of gel. Potential and impedance variations were measured for electrode movements in electrolytes relative to the skin. The impedance variations were small and streaming potentials with a magnitude of up to 10μV were recorded. The deformation potentials generated in the skin dominate the disturbance pattern in surface electrode recordings. Potential and impedance variations studied with varying mechanical stress upon skin showed that the impedance variations did not bring about the potential variations. The size of potential variations in skin and related mechanical stress possess a non-linear relationship which varies between individuals. A non-linear character of the time sequence of stretch potentials was found.

    The spread of deformation potentials was studied in the skin area around and beneath surface electrodes. When stretching a rectangular skin zone between two plates fixed to the skin the highest potentials were obtained in the zone. The magnitude of the potentials decreased with the distance to the zone. Stretch potentials could be reduced but not geometrically limited by fixing the skin to a rigid electrode collar. The potential spread is a consequence of successively decreasing deformation.

  • 26788.
    Ödén, Jakob
    et al.
    Stockholm University and RaySearch Laboratories AB, Stockholm, Sweden.
    Toma-Dasu, Iuliana
    Stockholm University and Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Kjell
    RaySearch Laboratories AB, Stockholm, Sweden.
    Flejmer, Anna M.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Dasu, Alexandru
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. The Skandion Clinic, Uppsala, Sweden.
    The influence of breathing motion and a variable relative biological effectiveness in proton therapy of left-sided breast cancer2017Inngår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, nr 11, s. 1428-1436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Proton breast radiotherapy has been suggested to improve target coverage as well as reduce cardiopulmonary and integral dose compared with photon therapy. This study aims to assess this potential when accounting for breathing motion and a variable relative biological effectiveness (RBE).

    Methods: Photon and robustly optimized proton plans were generated to deliver 50 Gy (RBE) in 25 fractions (RBE=1.1) to the CTV (whole left breast) for 12 patients. The plan evaluation was performed using the constant RBE and a variable RBE model. Robustness against breathing motion, setup, range and RBE uncertainties was analyzed using CT data obtained at free-breathing, breath-hold-at-inhalation and breath-hold-at-exhalation.

    Results: All photon and proton plans (RBE=1.1) met the clinical goals. The variable RBE model predicted an average RBE of 1.18 for the CTVs (range 1.14–1.21) and even higher RBEs in organs at risk (OARs). However, the dosimetric impact of this latter aspect was minor due to low OAR doses. The normal tissue complication probability (NTCP) for the lungs was low for all patients (<1%), and similar for photons and protons. The proton plans were generally considered robust for all patients. However, in the most extreme scenarios, the lowest dose received by 98% of the CTV dropped from 96 to 99% of the prescribed dose to around 92–94% for both protons and photons. Including RBE uncertainties in the robustness analysis resulted in substantially higher worst-case OAR doses.

    Conclusions: Breathing motion seems to have a minor effect on the plan quality for breast cancer. The variable RBE might impact the potential benefit of protons, but could probably be neglected in most cases where the physical OAR doses are low. However, to be able to identify outlier cases at risk for high OAR doses, the biological evaluation of proton plans taking into account the variable RBE is recommended.

  • 26789.
    Öfverholm, Anna
    et al.
    Department of Clinical Genetics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Einbeigi, Zakaria
    Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Manouchehrpour, Shokoufeh
    Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Albertsson, Per
    Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Skrtic, Stanko
    Department of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Enerbäck, Charlotta
    Department of Clinical Genetics, Sahlgrenska University Hospital, Göteborg, Sweden.
    The ABCB1 3435 T allele does not increasethe risk of paclitaxel-induced neurotoxicity2010Inngår i: Oncology Letters, ISSN 1792-1074, E-ISSN 1792-1082, Vol. 1, s. 151-154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Paclitaxel is a frequently used anticancer drug with considerable inter-individual variability in terms of drug efficiency and toxicity. The reasons for this variability have not been fully explained. The purpose of this study was to evaluate the possible relationship between paclitaxel-induced neurotoxicity and the distribution of genetic variations with reported functional significance in the ABCB1, CYP2C8 and CYP3A4 genes that are all implicated in taxol metabolism. Women (n=36) experiencing paclitaxel-induced neurotoxicity were included in the study, and the ABCB1 G2677A/T and C3435T as well as CYP2C8*3 and CYP3A4*1b allele frequencies were determined using PCR-RFLP and DNA sequence analysis. We showed that the ABCB1 3435T allele, previously reported as a risk allele for neurotoxicity, did not correlate with the occurrence of neurotoxicity in our patient sample (Chi-square test, p=0.61). Furthermore, we showed that neither the CYP2C8*3 nor CYP3A4*1b alleles, that both lead to diminished enzyme activity, correlated with paclitaxel-induced neurotoxicity. The occurrence and variation in severity of neurotoxicity in our Swedish patient sample could therefore not be explained by the reported functional polymorphisms in

    the ABCB1, CYP2C8 and CYP3A4 genes

    Fulltekst (pdf)
    FULLTEXT01
  • 26790.
    Öhlund, Carl
    et al.
    Central Hospital, Jönköping, Sweden.
    Fransson, Sven-Göran
    Central Hospital, Jönköping, Sweden.
    Starck, Sven-Åke
    Central Hospital, Jönköping, Sweden.
    Calf compression for prevention of thromboembolism following hip surgery1983Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 54, nr 6, s. 896-899Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A prospective, randomized trial of the effect of graded compression of the calf was done in 62 patients operated on electively for hip disease. After total hip arthroplasty, compression reduced the number of positive fibrinogen uptake tests by two-thirds, significant only in males, who seem to run a higher risk of thrombosis than females.

  • 26791.
    Öhlund, Sten-Erik
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Informatik. Linköpings universitet, Tekniska högskolan. eHealth Institute, Linnaeus University , Kalmar, Sweden.
    Åstrand, Bengt
    eHealth Institute, Linnaeus University, Kalmar, Sweden.
    Petersson, Göran
    eHealth Institute, Linnaeus University, Kalmar, Sweden.
    Improving interoperability in ePrescribing2012Inngår i: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 1, nr 2, artikkel-id e17Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The increased application of eServices in health care, in general, and ePrescribing (electronic prescribing) in particular, have brought quality and interoperability to the forefront. The application of standards has been put forward as one important factor in improving interoperability. However, less focus has been placed on other factors, such as stakeholders involvement and the measurement of interoperability. An information system (IS) can be regarded to comprise an instrument for technology-mediated work communication. In this study, interoperability refers to the interoperation in the ePrescribing process, involving people, systems, procedures and organizations. We have focused on the quality of the ePrescription message as one component of the interoperation in the ePrescribing process. Objective: The objective was to analyze how combined efforts in improving interoperability with the introduction of the new national ePrescription format (NEF) have impacted interoperability in the ePrescribing process in Sweden, with the focus on the quality of the ePrescription message. Methods: Consecutive sampling of electronic prescriptions in Sweden before and after the introduction of NEF was undertaken in April 2008 (pre-NEF) and April 2009 (post-NEF). Interoperability problems were identified and classified based on message format specifications and prescription rules. Results: The introduction of NEF improved the interoperability of ePrescriptions substantially. In the pre-NEF sample, a total of 98.6% of the prescriptions had errors. In the post-NEF sample, only 0.9% of the prescriptions had errors. The mean number of errors was fewer for the erroneous prescriptions: 4.8 in pre-NEF compared to 1.0 in post-NEF. Conclusions: We conclude that a systematic comprehensive work on interoperability, covering technical, semantical, professional, judicial and process aspects, involving the stakeholders, resulted in an improved interoperability of ePrescriptions.

    Fulltekst (pdf)
    fulltext
  • 26792.
    Öhman, Annika
    et al.
    Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Josephsson, Staffan
    Karolinska Insitutet.
    Nygård, Louise
    Karolinska Institutet.
    Awareness through interaction in everyday occupations: experiences of people with Alzheimer's disease2008Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, nr 1, s. 43-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to explore and describe the characteristics of awareness of the consequences of having Alzheimer's disease on everyday life occupations. Six community-dwelling participants with Alzheimer's disease were interviewed on repeated occasions about their lived experiences of everyday occupations. A phenomenological method was adopted for the analysis. The findings show that the participants discovered and explored the changes in how they performed everyday occupations in the context of their social relations and through immediate reflections on their forgetfulness. They attempted to handle the changes by adapting their behaviour. Awareness of the changes in their lives was evident in their reflections, as they tried to make sense of what was happening to them. This seemed to be related to an elusive perception of change in situations that they found impossible to influence. The participants reflected on the impact their condition had on other people near them. Their reflections also involved emotional reactions to the shortcomings they experienced. In conclusion, the findings show how these people with Alzheimer's disease were able to express awareness of the consequences of their illness through their reflections on their experiences of interaction with the occupations and the social environment.Read More: http://informahealthcare.com/doi/abs/10.1080/11038120701441080

  • 26793.
    Öhman, Annika
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, NISAL - Nationella institutet för forskning om äldre och åldrande. Linköpings universitet, Medicinska fakulteten.
    Nygård, Louise
    Karolinska Institutet.
    Meanings and motives for for engagement in self-chosen daily life occupations among individuals with Alzheimer's disease.2005Inngår i: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 25, nr 3, s. 89-97Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to uncover and describe the meanings and motives for engagement in self-chosen daily life occupations for elderly individuals with Alzheimer's disease dwelling in the community. Six participants with Alzheimer's disease were included. Data were collected through repeated interviews and observations focusing on their motives for their self-chosen occupational engagement and the significance of the daily occupations. The analysis used a qualitative comparative and interpretative method. The findings show that the participants' occupations supported their ordinary pattern of everyday life and provided them with an opportunity to be in a coherent context. The occupations also allowed them to experience and communicate autonomy and certain characteristics of their identity and provided them with a private sphere. The findings revealed certain crucial but double-edged environmental keys to occupation. By identifying and supporting everyday occupations with personal meaning and value, therapists and caregivers may contribute to the well-being of individuals with Alzheimer's disease living in their own homes.

  • 26794.
    Öhman, Annika
    et al.
    Division of Occupational Therapy, Karolinska Institutet.
    Nygård, Louise
    Karolinska Institutet.
    Borell, Lena
    Karolinska Institutet.
    The vocational situation in cases of memory deficits and younger-onset dementia.2001Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, nr 1, s. 34-43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study was to describe how persons with memory deficits or younger-onset dementia perceived and met their problems, with particular reference to their present and future vocational situation, including describing the parallel observations and attitudes of other significant persons in the vocational context. Data were collected through 16 interviews, one with each of nine subjects and seven respondents from the subjects' work-places. All interviews were analysed with a comparative method, searching for themes. In addition, subjects' IADL (instrumental activities of daily living) ability and cognition were assessed. The findings demonstrated that the subjects themselves experienced extensive difficulties before their predicament was defined. The difficulties were met by spontaneous and planned strategies on the part of the subjects and by adaptations at the workplaces, but with limited success. The situation also profoundly affected fellow workers. Overall, both the subjects and the work-place respondents had a positive attitude to continued work as long as the subjects made useful contributions. The possibility of remaining in work seemed to depend on multiple factors, including the individual's apprehension of his or her own ability and the length of the sick-leave.

  • 26795.
    Öhman, Annika
    et al.
    Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Nygård, Louise
    Karolinska Institutet.
    Kottorp, Anders
    Karolinska Institutet.
    Occupational performance and awareness of disability in mild cognitive impairment or dementia.2011Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 18, nr 2, s. 133-142Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Limited awareness of disabilities is common in mild cognitive impairment and dementia. In order to get a broader base in planning interventions, it is important to consider a person's awareness of his/her disability encountered in performance. The aim of this study was to examine the relationship between occupational performance and awareness of disability in older adults with mild cognitive impairment or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). Many-faceted Rasch models generated individual measures of ADL performance and awareness of disability. Non-parametric correlation statistics were used to analyse the relationships. The findings showed that there was an overall positive relationship between occupational performance and awareness of disability. However, individual variations in the sample implied that limitations in performance were not equivalent to a limited awareness of disability. In conclusion, awareness of disability should be individually evaluated when planning interventions together with clients and their families.Read More: http://informahealthcare.com/doi/abs/10.3109/11038121003645993

  • 26796.
    Öhman, Daniel
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Bioanalytical development for application in therapeutic drug monitoring: focus on drugs used in psychiatry2003Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: Since the 1950s and onwards, many new psychoactive drugs have been successfully introduced in clinical practice. A common feature of these drugs is a profound metabolism before clearance from the body. Genetic and phenotypic factors among patients can be anticipated to interact with the metabolism and therefore a major variance in the drug concentration between patients upon the same dose may be found. In later years there has been an increasing awareness, that the individual drug metabolism and drug body disposition do not only refer to the parent compound and major metabolites but also to the separate enantiomers in the case of chiral drugs.

    Bioanalytical methods for determination of drug concentrations have constantly been developed to assess the large pharmacokinetic variability of these drugs. Moreover, in the psychopharmacological practice these methods are often extended into a "Therapeutic Drug Monitoring (TDM) Service". A TDM service is used to determine the patient-specific drug analytical outcome in order to assess the precision in dose prescription as well as to recommend adequate dose adjustments for a particular patient.

    Aim: The aim was to develop bioanalytical methods, utilising high performance liquid chromatography, for serum determinations in patients under chronic dosing schedules for some recently introduced drugs used in psychiatry.

    Firstly, for the antidepressant drug reboxetine by an achiral methodology (paper I) consecutively extended to an enantioselective methodology for the individual enantiomers of the drug (paper II and III). Thereafter, after the evaluation of on-line extraction as an automated alternative to manually performed solid phase extraction for sample preparation (paper IV), apply on-line extraction in combination with ion-trap mass spectrometry detection for serum determination of the novel antipsychotic drug ziprasidone (paper V).

    Results and Conclusion: The methodology described in paper I has been applied on more than 500 patient samples from the naturalistic clinical practice as well as from controlled clinical trials. The methodology has proven robust and reliable and, although manually performed, easy to handle. The kinetic outcome display a great variability in concentration outcome even within the same prescribed dose, i.e. through level samples in steady-state were found to be 660±400 nM on 8 mg/day.

    Paper II, which describes the development of three approaches for direct chiral separation of reboxetine and O-deethylreboxetine enantiomers in the reversed phase mode, is in itself new and important. It is however, after applying MS2 detection, in paper III that the methodology is extended to include patients, i.e. patients from two separate clinical trials. Trial I comprised 23 patients on monotherapy with reboxetine and trial II comprised 47 patient from a naturalistic clinical setting. The pharrnacokinetic outcome displayed a S,S- over R,R-reboxetine ratio of about 0.5 with a rather pronounced inter-individual ratio (i.e. 0.2 to 0.9). The enantiomeric ratio did not correlate to the overall reboxetine concentration and the enantiomeric ratio was about 30% higher in females than in males. Repeated samples were analysed for trial I patients displaying an inter-individual coefficient of variation (CV) of about 17% meanwhile the intra-individual CV was about 4%. Calculating the noradrenaline reuptake inhibition (NARI) -activity out of the individual enantiomeric ratios showed that females may have a higher NARI-activity than males at a given reboxetine concentration.

    Paper IV proves that online extraction offers a robust, reliable and, for the analyst, time saving alternative (above 80%) to manually performed off-line solid phase extraction for sample preparation (citalopram and its demethylated metabolites were used as model substances).

    Paper V describes the development of a TDM process for ziprasidone and its S-methylated metabolite. The sample handling as well as the analytical process was subjected to a solid and satisfactory validation. It was proved that the lack of selectivity during on-line extraction can be compensated for by a selective form of detection, i.e. mass spectrometric detection.

    Delarbeid
    1. Bioanalysis of racemic reboxetine and its desethylated metabolite in a therapeutic drug monitoring setting using solid phase extraction and HPLC
    Åpne denne publikasjonen i ny fane eller vindu >>Bioanalysis of racemic reboxetine and its desethylated metabolite in a therapeutic drug monitoring setting using solid phase extraction and HPLC
    2001 (engelsk)Inngår i: Therapeutic Drug Monitoring, ISSN 0163-4356, E-ISSN 1536-3694, Vol. 23, nr 1, s. 27-34Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Reboxetine isa new antidepressant drug acting as a potent and selective noradrenaline reuptake inhibitor on the noradrenergic neuronal system. Because of an expected interindividual variability in drug metabolism in the clinical practice the need for therapeutic drug monitoring routines in psychiatry is always a prominent feature. In this application, the preferred bioanalytic methodology was solid phase extraction combined with reversed-Phase high-Performance liquid chromatography and ultraviolet detection at 210 nm. The technique proved reliable, with interday and intraday variation of less than 5% and a quantification limit for reboxetine and one of its main metabolites O-Desethylreboxetine (O-Reboxetine) at 5 and 30 nmol/L, respectively. The method was applied on serum samples from 38 patients treated chronically with reboxetine. These samples were drawn as trough levels in steady state with a dosage range of 2-16 mg/day. They evidenced a mean reboxetine concentration that was fairly linear and dose proportional, although the variance in concentration was large between patients, even those taking the same dosage. O-Reboxetine was detected in quantifiable amounts in only 1 of the 38 patients (<3%). In conclusion, these results suggest that a routine reboxetine therapeutic drug monitoring service that is robust enough to produce reliable and reproducible results may be introduced into everyday clinical practice.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27057 (URN)10.1097/00007691-200102000-00006 (DOI)11206039 (PubMedID)11703 (Lokal ID)11703 (Arkivnummer)11703 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    2. Simultaneous determination of reboxetine and O-desethylreboxetine enantiomers using enantioselective reversed-phase high-performance liquid chromatography
    Åpne denne publikasjonen i ny fane eller vindu >>Simultaneous determination of reboxetine and O-desethylreboxetine enantiomers using enantioselective reversed-phase high-performance liquid chromatography
    2002 (engelsk)Inngår i: Journal of Chromatography A, ISSN 0021-9673, E-ISSN 1873-3778, Vol. 947, nr 2, s. 247-254Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Current knowledge of stereoselective pharmacokinetics and different potencies of drug enantiomers requires the performance of stereoselective analysis during therapeutic drug monitoring in clinical practice. However, in the case of the new antidepressant drug reboxetine, no effort has been made so far to find a such a suitable system. Therefore, as a step towards developing an enantioselective bioanalytical method for reboxetine and the O-desethylreboxetine metabolite, three stereoselective chromatographic approaches have been investigated. Several chiral columns were tested, among them Chiral-AGP, ChiraGrom 2 and Chiral-CBH, which were able to simultaneously separate the two compounds into enantiomers in total running times of 28, 18 and 12 min, respectively.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27058 (URN)10.1016/S0021-9673(02)00012-2 (DOI)11704 (Lokal ID)11704 (Arkivnummer)11704 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    3. Determination of serum reboxetine enantiomers in patients on chronic medication with racemic reboxetine
    Åpne denne publikasjonen i ny fane eller vindu >>Determination of serum reboxetine enantiomers in patients on chronic medication with racemic reboxetine
    2003 (engelsk)Inngår i: Therapeutic Drug Monitoring, ISSN 0163-4356, E-ISSN 1536-3694, Vol. 25, nr 2, s. 174-182Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The chiral compound reboxetine is used as a selective noradrenaline re-uptake inhibitor (NARI) for the treatment of major depressive disorders. The pharmacokinetic variability of the enantiomers of the drug (S,S- and R,R-reboxetine) was studied using stereoselective high-performance liquid chromatography with mass spectrometric detection in a controlled clinical monotherapy situation (trial I) and a naturalistic clinical setting (trial II). Trial I included patients receiving racemic reboxetine as 6-month monotherapy for treatment of major depressive disorder. Trough level serum samples in steady state were analyzed for the concentration of the reboxetine enantiomers in study weeks 4, 12, and 24. In a therapeutic drug monitoring setting (trial II), 47 patients on doses ranging from 4 to 16 mg daily, including much polypharmacy, trough level steady-state serum samples were analyzed by the same bioanalytical method. Data from trials I and II were assessed to determine the inter- and intraindividual pharmacokinetic outcomes. The results showed that the median S,S/R,R ratio in steady state was 0.5 and ranged from 0.22 to 0.88. It was also shown that women have an approximately 30% higher S,S/R,R ratio than men. The S,S/R,R ratios of reboxetine were not found to correlate with reboxetine concentrations. To investigate the NARI activity of a circulating serum reboxetine concentration, a recalculation of the determined enantiomeric concentrations to previously demonstrated experimental NARI potencies of the drug enantiomers was performed. This partly novel concept of estimating pharmacodynamic activity showed that the serum NARI activity in women tended to be higher than in men at a given reboxetine concentration. In conclusion, the variability in the NARI activity per nmol/L reboxetine and the variability in the concentration outcome of the reboxetine enantiomers may justify the use of enantioselective drug monitoring in the clinic. The gender aspects of the drug have to be further assessed.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-26798 (URN)10.1097/00007691-200304000-00006 (DOI)11406 (Lokal ID)11406 (Arkivnummer)11406 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    4. On-line extraction using an alkyl-diol silica precolumn for racemic citalopram and its metabolites in plasma: results compared with solid-phase extraction methodology
    Åpne denne publikasjonen i ny fane eller vindu >>On-line extraction using an alkyl-diol silica precolumn for racemic citalopram and its metabolites in plasma: results compared with solid-phase extraction methodology
    2001 (engelsk)Inngår i: Journal of Chromatography B: Biomedical Sciences and Applications, ISSN 1387-2273, E-ISSN 1878-5603, Vol. 753, nr 2, s. 365-373Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Sample preparation is usually the most critical and time consuming step when using HPLC for drug analysis in biological matrixes. Sample extracts have to be clean considering both chromatographic interferences and column maintenance. To meet some of these criteria a fully automated on-line extraction (OLE) analysis method was developed for the antidepressant drug citalopram and its two demethylated metabolites, using an RP-C4-ADS extraction column. A comparison between the new OLE method and an off-line solid-phase extraction method showed that the two methodologies were equal in analytical precision but that the OLE method was faster and therefore superior in sample capacity per day.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-26834 (URN)10.1016/S0378-4347(00)00579-X (DOI)11449 (Lokal ID)11449 (Arkivnummer)11449 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    5. Biolanalysis of ziprasidone and its S-methylated metabolite in serum using on-line extraction and liquid chromatography-masspectrometry
    Åpne denne publikasjonen i ny fane eller vindu >>Biolanalysis of ziprasidone and its S-methylated metabolite in serum using on-line extraction and liquid chromatography-masspectrometry
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The novel antipsychotic agent Ziprasidone, (Zip) was introduced for clinical prescription in Sweden in the early spring of 2001. As of yet, no bioanalytical procedure suitable for a Therapeutic Drug Monitoring (TDM)-service of the drug has been presented. Therefore a bioanalytical methodology utilising online extraction on RP-C4-ADS columns combined with ion-trap masspectrometric detection for determination of Zip and its S-methylated metabolite (Smd-Zip) was developed. The stability of the analytes in serum was determined for establishing a correct sample handling procedure.

    The calibration model for Zip and Smd-Zip had a linear response function in the concentration range 20 to 500 and 15 to 300 nM, respectively. The intra- and inter-day coefficient of variance was below 10% for all calibrator levels for both Zip and Smd-Zip. Validation of the sample handling procedure showed that samples are stable in room temperature or refrigerator for 3 days. Repeated freeze/thaw cycles, for five times did not affect the Zip or Smd-Zip concentration. In essence these findings state the importance of a correct sampling procedure for a functional ID M-procedure.

    The TDM-procedure was applied on 10 patient serum samples obtained from a naturalistic clinical setting. The obtained concentrations, ranging from 66 to 432 nM for Zip and 42 to 220 nM for Smd-Zip were within the dynamic range of the present methodology. Thus, a future utility for this newly developed method in a TDM-setting seems evident.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-84595 (URN)
    Tilgjengelig fra: 2012-10-15 Laget: 2012-10-15 Sist oppdatert: 2012-10-15bibliografisk kontrollert
  • 26797.
    Öhman, Daniel
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Björkman, Helena
    Department of Analytical Chemistry, Stockholm University, Stockholm, Sweden.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Biolanalysis of ziprasidone and its S-methylated metabolite in serum using on-line extraction and liquid chromatography-masspectrometryManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The novel antipsychotic agent Ziprasidone, (Zip) was introduced for clinical prescription in Sweden in the early spring of 2001. As of yet, no bioanalytical procedure suitable for a Therapeutic Drug Monitoring (TDM)-service of the drug has been presented. Therefore a bioanalytical methodology utilising online extraction on RP-C4-ADS columns combined with ion-trap masspectrometric detection for determination of Zip and its S-methylated metabolite (Smd-Zip) was developed. The stability of the analytes in serum was determined for establishing a correct sample handling procedure.

    The calibration model for Zip and Smd-Zip had a linear response function in the concentration range 20 to 500 and 15 to 300 nM, respectively. The intra- and inter-day coefficient of variance was below 10% for all calibrator levels for both Zip and Smd-Zip. Validation of the sample handling procedure showed that samples are stable in room temperature or refrigerator for 3 days. Repeated freeze/thaw cycles, for five times did not affect the Zip or Smd-Zip concentration. In essence these findings state the importance of a correct sampling procedure for a functional ID M-procedure.

    The TDM-procedure was applied on 10 patient serum samples obtained from a naturalistic clinical setting. The obtained concentrations, ranging from 66 to 432 nM for Zip and 42 to 220 nM for Smd-Zip were within the dynamic range of the present methodology. Thus, a future utility for this newly developed method in a TDM-setting seems evident.

  • 26798.
    Öhman, Daniel
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Cherma Yeste, Maria Dolores
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Norlander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Determination of serum reboxetine enantiomers in patients on chronic medication with racemic reboxetine2003Inngår i: Therapeutic Drug Monitoring, ISSN 0163-4356, E-ISSN 1536-3694, Vol. 25, nr 2, s. 174-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The chiral compound reboxetine is used as a selective noradrenaline re-uptake inhibitor (NARI) for the treatment of major depressive disorders. The pharmacokinetic variability of the enantiomers of the drug (S,S- and R,R-reboxetine) was studied using stereoselective high-performance liquid chromatography with mass spectrometric detection in a controlled clinical monotherapy situation (trial I) and a naturalistic clinical setting (trial II). Trial I included patients receiving racemic reboxetine as 6-month monotherapy for treatment of major depressive disorder. Trough level serum samples in steady state were analyzed for the concentration of the reboxetine enantiomers in study weeks 4, 12, and 24. In a therapeutic drug monitoring setting (trial II), 47 patients on doses ranging from 4 to 16 mg daily, including much polypharmacy, trough level steady-state serum samples were analyzed by the same bioanalytical method. Data from trials I and II were assessed to determine the inter- and intraindividual pharmacokinetic outcomes. The results showed that the median S,S/R,R ratio in steady state was 0.5 and ranged from 0.22 to 0.88. It was also shown that women have an approximately 30% higher S,S/R,R ratio than men. The S,S/R,R ratios of reboxetine were not found to correlate with reboxetine concentrations. To investigate the NARI activity of a circulating serum reboxetine concentration, a recalculation of the determined enantiomeric concentrations to previously demonstrated experimental NARI potencies of the drug enantiomers was performed. This partly novel concept of estimating pharmacodynamic activity showed that the serum NARI activity in women tended to be higher than in men at a given reboxetine concentration. In conclusion, the variability in the NARI activity per nmol/L reboxetine and the variability in the concentration outcome of the reboxetine enantiomers may justify the use of enantioselective drug monitoring in the clinic. The gender aspects of the drug have to be further assessed.

  • 26799.
    Öhman, Daniel
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Norlander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Björn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    On-line extraction using an alkyl-diol silica precolumn for racemic citalopram and its metabolites in plasma: results compared with solid-phase extraction methodology2001Inngår i: Journal of Chromatography B: Biomedical Sciences and Applications, ISSN 1387-2273, E-ISSN 1878-5603, Vol. 753, nr 2, s. 365-373Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sample preparation is usually the most critical and time consuming step when using HPLC for drug analysis in biological matrixes. Sample extracts have to be clean considering both chromatographic interferences and column maintenance. To meet some of these criteria a fully automated on-line extraction (OLE) analysis method was developed for the antidepressant drug citalopram and its two demethylated metabolites, using an RP-C4-ADS extraction column. A comparison between the new OLE method and an off-line solid-phase extraction method showed that the two methodologies were equal in analytical precision but that the OLE method was faster and therefore superior in sample capacity per day.

  • 26800.
    Öhman, Daniel
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Norlander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Peterson, Curt
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Bioanalysis of racemic reboxetine and its desethylated metabolite in a therapeutic drug monitoring setting using solid phase extraction and HPLC2001Inngår i: Therapeutic Drug Monitoring, ISSN 0163-4356, E-ISSN 1536-3694, Vol. 23, nr 1, s. 27-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reboxetine isa new antidepressant drug acting as a potent and selective noradrenaline reuptake inhibitor on the noradrenergic neuronal system. Because of an expected interindividual variability in drug metabolism in the clinical practice the need for therapeutic drug monitoring routines in psychiatry is always a prominent feature. In this application, the preferred bioanalytic methodology was solid phase extraction combined with reversed-Phase high-Performance liquid chromatography and ultraviolet detection at 210 nm. The technique proved reliable, with interday and intraday variation of less than 5% and a quantification limit for reboxetine and one of its main metabolites O-Desethylreboxetine (O-Reboxetine) at 5 and 30 nmol/L, respectively. The method was applied on serum samples from 38 patients treated chronically with reboxetine. These samples were drawn as trough levels in steady state with a dosage range of 2-16 mg/day. They evidenced a mean reboxetine concentration that was fairly linear and dose proportional, although the variance in concentration was large between patients, even those taking the same dosage. O-Reboxetine was detected in quantifiable amounts in only 1 of the 38 patients (<3%). In conclusion, these results suggest that a routine reboxetine therapeutic drug monitoring service that is robust enough to produce reliable and reproducible results may be introduced into everyday clinical practice.

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