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  • 99401.
    Zare, Fariba
    et al.
    University of Gothenburg, Sweden.
    Magnusson, Mattias
    University of Gothenburg, Sweden.
    Bergstrom, Tomas
    University of Gothenburg, Sweden.
    Brisslert, Mikael
    University of Gothenburg, Sweden.
    Josefsson, Elisabet
    University of Gothenburg, Sweden.
    Karlsson, Anna
    University of Gothenburg, Sweden.
    Tarkowski, Andrej
    University of Gothenburg, Sweden.
    Uric acid, a nucleic acid degradation product, down-regulates dsRNA-triggered arthritis2006In: Journal of Leukocyte Biology, ISSN 0741-5400, E-ISSN 1938-3673, Vol. 79, no 3, p. 482-488Article in journal (Refereed)
    Abstract [en]

    Uric acid, the naturally occurring degradation product of purine metabolism, is a danger signal, driving maturation of dendritic cells. It is well known that uric acid crystals display potent proinflammatory properties-the cause of gout-whereas the biological properties of soluble uric acid are less well documented. We have demonstrated previously that nucleic acids of endogenous and exogenons origin display proinflammatory properties. The aim of the present study was to assess the impact of soluble uric acid on in vivo inflammatory responses. Mice were administered with uric acid suspension in saline or saline alone prior to induction of nentrophil-mediated inflammation, delayed-type hypersensitivity, histamin-induced edema (measure of vasodilation capacity), as well as double-stranded (ds)RNA-triggered arthritis. Frequency and severity of arthritis were decreased significantly in mice exposed to dsRNA and simultaneously treated with uric acid as compared with salline-treated controls. Also, granulocyte-mediated inflammatory response and vasodilation capacity were reduced significantly in mice treated with uric acid as compared with their control group. The data suggest that down-regulation of inflammation was mediated by skewing the inflammatory response from the peripheral sites to the peritoneal cavity and down-regulating vasodilatatory capacity and thereby affecting leukocyte migration. In contrast, the T cell-mediated delayed-type hypersensitivity reaction was not affected significantly in mice exposed to uric acid. These findings demonstrate that uric acid displays a potent, distant anti-inflammatory effect in vivo. This property seems to be mediated by down-regulation of nentrophil influx to the site of inflammatory insult.

  • 99402.
    Zare, Fariba
    et al.
    University of Gothenburg, Sweden .
    Magnusson, Mattias
    University of Gothenburg, Sweden .
    Nilsson Mollers, Linda
    University of Gothenburg, Sweden .
    Jin, Tao
    University of Gothenburg, Sweden .
    Tarkowski, Andrej
    University of Gothenburg, Sweden .
    Bokarewa, Maria
    University of Gothenburg, Sweden .
    Single-stranded polyinosinic acid oligonucleotides trigger leukocyte production of proteins belonging to fibrinolytic and coagulation cascades2008In: Journal of Leukocyte Biology, ISSN 0741-5400, E-ISSN 1938-3673, Vol. 84, no 3, p. 741-747Article in journal (Refereed)
    Abstract [en]

    The present study assessed the inductory effects of ds- and ssRNA on the leukocyte production of proteins belonging to fibrinolytic and coagulation cascades. Murine splenocytes were stimulated with dsRNA [polyinosinic: polycytidylic acid (polyIC)] and ssRNA sequences [polyinosinic acid (polyI), polycytidylic acid (polyC), and polyuridylic acid (polyU)]. The expression of plasminogen (Plg), tissue factor (TF), IL-6, and IFN-alpha was assessed. Intracellular tranduction mechanisms activated by oligonucleotides were evaluated using specific inhibitors of signaling pathways and genetically modified mice. polyIC efficiently and dose-dependently induced the expression of Plg, IL-6, and IFN-alpha, whereas TF was not induced by polyIC. polyI was unable to trigger IFN-alpha production, and it was efficiently inducing Plg and TF. IFN-alpha R and dsRNA-dependent protein kinase signaling were not required for the polyI-induced production of Plg or TF. Neither polyU nor polyC induced the expression of Plg or TF. Importantly, the presence of U- and C-nucleotide strands in the dsRNA significantly reduced expression of Plg and TF compared with polyI alone. Exposure of splenocytes to polyI activated the NF-kappa B pathway followed by the expression of TF and IL-6. In contrast, Plg production did not require NF-kappa B, was only partly down-regulated by p38 MAPK inhibitor, and was efficiently inhibited by insulin, indicating a different mechanism for its induction. ssRNA exerts its TF-generating properties through NF-kappa B activation in an IFN-alpha-independent manner. The expression of fibrinolytic versus coagulation proteins is regulated through distinctly different transduction pathways. As fibrinolytic and coagulation cascades are important components of inflammatory homeostatis, these findings might have importance for developement of new, targeted therapies.

  • 99403.
    Zarechnaya, E Yu
    et al.
    University of Bayreuth.
    Dubrovinsky, L
    University of Bayreuth.
    Dubrovinskaia, N
    University of Bayreuth.
    Filinchuk, Y
    Swiss Norwegian Beam Lines ESRF.
    Chernyshov, D
    Swiss Norwegian Beam Lines ESRF.
    Dmitriev, V
    Swiss Norwegian Beam Lines ESRF.
    Miyajima, N
    University of Bayreuth.
    Goresy, A El
    University of Bayreuth.
    Braun, H F
    University of Bayreuth.
    Kantor, I
    University of Chicago.
    Kantor, A
    University of Chicago.
    Prakapenka, V
    University of Chicago.
    Hanfland, M
    ESRF.
    Mikhaylushkin, Arkady
    Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics . Linköping University, The Institute of Technology.
    Abrikosov, Igor
    Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics . Linköping University, The Institute of Technology.
    Simak, Sergey
    Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics . Linköping University, The Institute of Technology.
    Superhard Semiconducting Optically Transparent High Pressure Phase of Boron2009In: PHYSICAL REVIEW LETTERS, ISSN 0031-9007, Vol. 102, no 18, p. 185501-Article in journal (Refereed)
    Abstract [en]

    An orthorhombic (space group Pnnm) boron phase was synthesized at pressures above 9 GPa and high temperature, and it was demonstrated to be stable at least up to 30 GPa. The structure, determined by single-crystal x-ray diffraction, consists of B-12 icosahedra and B-2 dumbbells. The charge density distribution obtained from experimental data and ab initio calculations suggests covalent chemical bonding in this phase. Strong covalent interatomic interactions explain the low compressibility value (bulk modulus is K-300=227 GPa) and high hardness of high-pressure boron (Vickers hardness H-V=58 GPa), after diamond the second hardest elemental material.

  • 99404.
    Zarechnaya, E. Yu.
    et al.
    Moscow Institute of Steel and Alloys.
    Skorodumova, N.V.
    Uppsala University.
    Simak, Sergey.I.
    Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics . Linköping University, The Institute of Technology.
    Johansson, B.
    Royal Institute of Technology, Stockholm.
    Isaev, Eyvas I.
    Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics . Linköping University, The Institute of Technology.
    Theoretical study of linear monoatomic nanowires, dimer and bulk of Cu, Ag, Au, Ni, Pd and Pt2008In: Computational materials science, ISSN 0927-0256, E-ISSN 1879-0801, Vol. 43, no 3, p. 522-530Article in journal (Refereed)
    Abstract [en]

    The binding and electronic properties of monoatomic nanowires, dimers and bulk structures of Cu, Ag, Au and Ni, Pd, Pt have been studied by the projector augmented-wave method (PAW) within the density functional theory (DFT) using the local density approximation (LDA) as well as generalized gradient approximation (GGA) in both Perdew–Wang (PW91) and Perdew–Burke–Ernzerhof (PBE) parameterizations. Our results show that the formation of atomic chains is not equally plausible for all the studied elements. In agreement with experimental observations Pt and Au stand out as most likely elements to form monoatomic wires. Changes in the electronic structure and magnetic properties of metal chains at stretching are analyzed.

  • 99405.
    Zarechnaya, E.Yu.
    et al.
    Bayerisches Geoinstitut University of Bayreuth, Bayreuth, Germany.
    Isaev, E.I.
    Moscow State Institute of Steel and Alloys, Moscow, Russia.
    Simak, Sergey
    Linköping University, The Institute of Technology. Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics .
    Vekilov, Yu. Kh.
    Moscow State Institute of Steel and Alloys. Moscow, Russia.
    Dubrovinsky, L.S.
    Bayerisches Geoinstitut, University of Bayreuth, Bayreuth, Germany.
    Dubrovinskaia, N.A.
    University of Heidelberg, Heidelberg, Germany.
    Abrikosov, Igor
    Linköping University, The Institute of Technology. Linköping University, Department of Physics, Chemistry and Biology, Theoretical Physics .
    Ground-State Properties of Boron-Doped Diamond2008In: Journal of Experimental and Theoretical Physics, ISSN 1063-7761, E-ISSN 1090-6509, Vol. 106, p. 781-787Article in journal (Refereed)
  • 99406. Zareie, M
    et al.
    Johnson-Henry, K
    Jury, J
    Yang, P-C
    Ngan, B-Y
    McKay, DM
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Perdue, MH
    Sherman, PM
    Probiotics prevent bacterial translocation and improve intestinal barrier function in rats following chronic psychological stress2006In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 55, no 11, p. 1553-1560Article in journal (Refereed)
    Abstract [en]

    Background and aim: Chronic psychological stress, including water avoidance stress (WAS), induces intestinal mucosal barrier dysfunction and impairs mucosal defences against luminal bacteria. The aim of this study was to determine the ability of a defined probiotic regimen to prevent WAS induced intestinal pathophysiology. Methods: Male rats were subjected to either WAS or sham stress for one hour per day for 10 consecutive days. Additional animals received seven days of Lactobacillus helveticus and L. rhamnosus in the drinking water prior to stress and remained on these probiotics for the duration of the study. Rats were then sacrificed, intestinal segments assessed in Ussing chambers, and mesenteric lymph nodes cultured to determine bacterial translocation. Results: All animals remained healthy for the duration of the study. Chronic WAS induced excess ion secretion (elevated baseline short circuit current) and barrier dysfunction (increased conductance) in both the ileum and colon, associated with increased bacterial adhesion and penetration into surface epithelial cells. Approximately 70% of rats subjected to WAS had bacterial translocation to mesenteric lymph nodes while there was no bacterial translocation in controls. Probiotic pretreatment alone had no effect on intestinal barrier function. However, WAS induced increased ileal short circuit current was reduced with probiotics whereas there was no impact on altered conductance. Pretreatment of animals with probiotics also completely abrogated WAS induced bacterial adhesion and prevented translocation of bacteria to mesenteric lymph nodes. Conclusion: These findings indicate that probiotics can prevent chronic stress induced intestinal abnormalities and, thereby, exert beneficial effects in the intestinal tract.

  • 99407. Zareie, Mehri
    et al.
    Riff, Jason
    Donato, Kevin
    McKay, Derek M
    Perdue, Mary H
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Karmali, Mohamed
    Cohen, Mitchell B
    Hawkins, Jennifer
    Sherman, Philip M
    Novel effects of the prototype translocating Escherichia coli, strain C25 on intestinal epithelial structure and barrier function2005In: Cellular Microbiology, ISSN 1462-5814, E-ISSN 1462-5822, Vol. 7, no 12, p. 1782-1797Article in journal (Refereed)
    Abstract [en]

    Intestinal bacteria play an etiologic role in triggering and perpetuating chronic inflammatory bowel disorders. However, the precise mechanisms whereby the gut microflora influences intestinal cell function remain undefined. Therefore, the effects of the non-pathogenic prototype translocating Escherichia coli, strain C25 on the barrier properties of human T84 and Madine-Darby canine kidney type 1 epithelial cells were examined. T-84 cells were also infected with commensal E. coil, strains F18 and HB101, and enterohaemorrhagic E. coli, serotype O157:H7. Strains F18 and HB101 had no effect on transepithelial electrical resistance (TER) of T84 monolayers. By contrast, epithelial cells infected with strain C25 displayed a time-dependent decrease in TER, preceded by an altered distribution of the cytoskeletal protein alpha-actinin, comparable to infection with E. coli O157:H7. E. coli C25 infection also led to activation of nuclear factor κB (NF-κB), interleukin-8 secretion and alterations in localization of claudin-1, but not zona occludens-1 or claudin-4, in T84 cells. There were adherent C25 bacteria on the intact apical surface of infected T84 cells, while mitochondria appeared swollen and vacuolated. These novel findings demonstrate the ability of a translocating commensal bacterium to adhere to and modulate intestinal epithelial barrier function and to induce morphological changes in a manner distinct from the known enteric pathogen, E. coli O157:H7. © 2005 Blackwell Publishing Ltd.

  • 99408.
    Zarenoe, Ramesh
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hansson, Magnus
    Karolinska University Hospital.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Assessment of diagnostic approaches to idiopathic sudden sensorineural hearing loss and their influence on treatment and outcome2010In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 3, p. 384-391Article in journal (Refereed)
    Abstract [en]

    Conclusion: Results from a database for sudden sensorineural hearing loss (SSNHL) demonstrate no correlation between laboratory findings, treatment, and outcome in 400 patients. The patients with pathological test results were not treated differently from those with normal test results. The value of laboratory findings and MRI might increase if the results are categorized to more specific diagnoses. Objectives: To investigate diagnostic test batteries for SSNHL and evaluate their value in the management of idiopathic SSNHL. Methods: A total of 400 patients submitted to the Swedish national database for SSNHL were analyzed. Information was collected about the patients past medical history, potential precipitating events, trauma, medical history, hearing loss, current disease, diagnostic protocol, and treatment, using questionnaires as well as two audiograms, one at the first ENT clinic visit and another 3 months later. Results: In all, 65% of these 400 patients underwent hematological tests and 40% had an MRI/CT scan. Twenty-two of 160 MRI investigated had pathological findings including 5 acoustic neuromas. Also, 300 of these 400 patients were evaluated as having idiopathic sudden sensorineural hearing loss (ISSNHL); 24% of them had one or more pathological test results. No significant correlation was found between either the MRI findings or the laboratory findings with regard to treatment or hearing recovery in patients with ISSNHL.

  • 99409.
    Zarenoe, Ramesh
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Corticosteroid Treatment of Idiopathic Sudden Sensorineural Hearing Loss: Randomized Triple-Blind Placebo-Controlled Trial2012In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 33, no 4, p. 523-531Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the effect of Prednisolone and placebo on the recovery of unilateral idiopathic sudden sensorineural hearing loss. less thanbrgreater than less thanbrgreater thanStudy Design: Prospective, randomized, triple-blind, placebo-controlled multicenter trial. less thanbrgreater than less thanbrgreater thanSetting: Four tertiary and 10 secondary referral centers. less thanbrgreater than less thanbrgreater thanPatients: Of 103 patients randomly assigned, 93 were included in the modified intention-to-treat analysis. The patients, aged 18 to 80 years, were seeking care within 1 week after onset of acute unilateral sensorineural hearing loss with a mean decrease of 30 dB or greater in the 3 most affected contiguous frequencies. less thanbrgreater than less thanbrgreater thanIntervention: Patients were randomly assigned in permuted blocks of 10 to receive Prednisolone or placebo in tapering doses from 60 mg for 3 days and, thereafter, 10 mg less each day until Day 8. If complete recovery, no more medication given, otherwise medication continued at 10 mg per day until Day 30. Final follow-up was after 3 months with audiogram; 47 patients received Prednisolone and 46 placebo. less thanbrgreater than less thanbrgreater thanMain Outcome Measure: The primary endpoint was efficacy of treatment on recovery at Day 90. Secondary endpoints were prognostic factors for hearing recovery. Analyses were by modified intention-to-treat and per protocol. less thanbrgreater than less thanbrgreater thanResults: Hearing improvement for 47 Prednisolone-treated patients was 25.5 +/- 27.1 dB compared to 26.4 +/- 26.2 dB for 46 placebo-treated patients at Day 8 and 39 +/- 20.1 dB versus 35.1 +/- 38.3 dB after 3 months. Vertigo had significant negative effect on hearing improvement and inflammatory signs in the laboratory workup-a positive prognostic effect, irrespective of treatment. less thanbrgreater than less thanbrgreater thanConclusion: Prednisolone in customary dosage does not seem to influence recovery of idiopathic sudden sensorineural hearing loss.

  • 99410.
    Zarenoe, Ramesh
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Arlinger, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Technical Audiology.
    Idiopatisk plötslig sensorineural hörselnedsättning2004In: Svensk ÖNH tidskrift, ISSN 1400-0121, Vol. 3Article in journal (Other (popular science, discussion, etc.))
  • 99411.
    Zarenoe, Reza
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tinnitus in Patients with Sensorineural Hearing Loss: Management and Quality of Life2012Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Approximately 15 % of Swedish people experience tinnitus, but only 2.4 % of them experience severe problems. Treatment modalities for tinnitus are varied, but the most common treatment model is counselling. The majority of patients with tinnitus report some degree of hearing loss, and in addition, hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment.

    The aim of the present thesis was to investigate the disease management and identify the quality of life in patients with tinnitus and sensorineural hearing loss.

    Both studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at the two ENT clinics in Östergötland County, Sweden, during 2004 - 2007 and who also received a diagnosis code. A medical record review of all patients (study I contained 1672 subjects) revealed that 714 patients were diagnosed with both tinnitus and SNHL between 2004 and 2007 and could be included in study II.

    The results showed that 70% of our cohort had tinnitus, but many of the patients initially did not receive a diagnosis for their tinnitus. Information about the patients’ vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to their health was often missing from the medical records. Our findings showed that the Stepped Care Model, which however was only used in a minority of the cases, could be effective in patients with tinnitus and could provide a better care process for these patients. Of the cohort, 56% of the patients received a diagnosis of bilateral hearing loss. The pure tone average (PTA) of the left ear was significantly higher than that of the right ear. There were 314 patients (44%) who had hearing aids out of the total of 714, even though it is likely that hearing aids could be beneficial for these patients. We found that the overall scores for the Tinnitus Handicap Inventory (THI) were higher in female patients than male patients. All patients who participated in study II estimated their life quality and general health at a good level. This could be due to the fact that they were investigated 4.5 years after they first reported their tinnitus and that tinnitus annoyance decrease over time. Further, the outcomes of study II demonstrated that the majority of patients, who were dissatisfied with the care they obtained, had no hearing aids. This could indicate a support the use of hearing aids fitting as main treatment model in patients with both tinnitus and hearing loss.

    Future research is needed to investigate how hearing aid professionals could motivate patients who suffer from both tinnitus and hearing loss to use hearing aids.

    List of papers
    1. A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    Open this publication in new window or tab >>A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    2013 (English)In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, p. 41-45Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

    METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

    RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

    CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81411 (URN)10.1016/j.anl.2012.05.005 (DOI)22652486 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07Bibliographically approved
    2. Quality of life in patients with tinnitus and sensorineural hearing loss
    Open this publication in new window or tab >>Quality of life in patients with tinnitus and sensorineural hearing loss
    2014 (English)In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, p. 41-51Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

    Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

    Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

    Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

    Place, publisher, year, edition, pages
    ROYAL BELGIAN SOC EAR, NOSE, THROAT, HEAD & NECK SURGERY, 2014
    Keywords
    Tinnitus, Sensorineural hearing loss, Questionnaire, Quality of life
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-81412 (URN)000334566200007 ()24765828 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-02-20Bibliographically approved
  • 99412.
    Zarenoe, Reza
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Tinnitus in Patients with Sensorineural Hearing Loss: Management, Quality of Life and Treatment Strategies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss.

    The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss.

    Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss.

    In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction.

    Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS.

    In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.

    List of papers
    1. A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    Open this publication in new window or tab >>A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
    2013 (English)In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, p. 41-45Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

    METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

    RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

    CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81411 (URN)10.1016/j.anl.2012.05.005 (DOI)22652486 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07Bibliographically approved
    2. Quality of life in patients with tinnitus and sensorineural hearing loss
    Open this publication in new window or tab >>Quality of life in patients with tinnitus and sensorineural hearing loss
    2014 (English)In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, p. 41-51Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

    Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

    Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

    Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

    Place, publisher, year, edition, pages
    ROYAL BELGIAN SOC EAR, NOSE, THROAT, HEAD & NECK SURGERY, 2014
    Keywords
    Tinnitus, Sensorineural hearing loss, Questionnaire, Quality of life
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-81412 (URN)000334566200007 ()24765828 (PubMedID)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-02-20Bibliographically approved
    3. Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
    Open this publication in new window or tab >>Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
    2017 (English)In: Journal of the American Academy of Audiology, ISSN 1050-0545, Vol. 28, no 2, p. 141-151Article in journal (Refereed) Published
    Abstract [en]

    Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated.

    Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation.

    Research Design: A prospective study.

    Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) ,70 dB HL.

    Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance.

    Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n 5 30 1 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation.

    Results: There were no between-group differences at baseline in the full sample (n 5 92), with the exception of the THI (p , 0.001) and the PSQI (p , 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p , 0.001) and the PSQI (p , 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline ( p, 0.001). We conducted the same analyses for the age-matched subsample (n 5 30 1 30). For the baseline data, only the THI (p , 0.001) and the PSQI (p , 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span ( p , 0.001) and the PSQI (p , 0.015) as in the full sample.

    Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

    Place, publisher, year, edition, pages
    American Academy of Audiology, 2017
    Keywords
    sensorineural hearing loss; hearing aids; tinnitus; working memory capacity
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Neurology Otorhinolaryngology Psychology
    Identifiers
    urn:nbn:se:liu:diva-132160 (URN)10.3766/jaaa.16023 (DOI)000394478500005 ()28240981 (PubMedID)2-s2.0-85014508703 (Scopus ID)
    Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2018-05-02Bibliographically approved
    4. Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
    Open this publication in new window or tab >>Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
    2016 (English)In: Journal of the American Academy of Audiology, ISSN 2157-3107, Vol. 27, no 8, p. 669--676Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss.

    RESEARCH DESIGN: This was a pilot randomized controlled trial.

    STUDY SAMPLE: The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users.

    INTERVENTION: A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation.

    DATA COLLECTION AND ANALYSIS: A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment.

    RESULTS: Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99).

    CONCLUSION: Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

    Place, publisher, year, edition, pages
    Reston: American Academy of Audiology, 2016
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:liu:diva-131111 (URN)10.3766/jaaa.15126 (DOI)000381957200006 ()27564444 (PubMedID)
    Available from: 2016-09-09 Created: 2016-09-09 Last updated: 2017-05-03Bibliographically approved
  • 99413.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Bohn Eriksson, Therese
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Dahl, Jakob
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Department of Clinical Neuroscience, Karolinska institute, Stockholm, Sweden.
    Multidisciplinary group information for patients with tinnitus: an open trial2018In: Hearing, Balance and Communication, ISSN 2169-5717Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to investigate the effects of a multidisciplinary group information as a part of a Stepped Care tinnitus management model. The Tinnitus Handicap Inventory (THI) and the Hospital Anxiety and Depression Scale (HADS) were administered before and after the group information to evaluate the effects.

    Method: In total, 627 patients participated in half-day tinnitus information meetings from 2004 to 2011 in our clinic. We retrieved 426 patients for analysis with complete scores on the THI, HADS, and a questionnaire covering background information. These three questionnaires were used before the information meeting, and the THI and HADS at a 1-month follow-up.

    Results: Significant decreases were found in scores on the THI (p < .001) and the HADS-A (p < .05), pre- and post-information session. However, no significant changes were observed on the HADS-D.

    Conclusion: An information meeting as a part of multidisciplinary Stepped Care model can be an effective initial approach to manage tinnitus, and serve as a filter for patients who need additional treatment.

  • 99414.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hällgren, Mathias
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids2017In: Journal of the American Academy of Audiology, ISSN 1050-0545, Vol. 28, no 2, p. 141-151Article in journal (Refereed)
    Abstract [en]

    Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated.

    Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation.

    Research Design: A prospective study.

    Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) ,70 dB HL.

    Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance.

    Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n 5 30 1 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation.

    Results: There were no between-group differences at baseline in the full sample (n 5 92), with the exception of the THI (p , 0.001) and the PSQI (p , 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p , 0.001) and the PSQI (p , 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline ( p, 0.001). We conducted the same analyses for the age-matched subsample (n 5 30 1 30). For the baseline data, only the THI (p , 0.001) and the PSQI (p , 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span ( p , 0.001) and the PSQI (p , 0.015) as in the full sample.

    Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

  • 99415.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population2013In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, p. 41-45Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

    METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

    RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

    CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

  • 99416.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Quality of life in patients with tinnitus and sensorineural hearing loss2014In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, p. 41-51Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

    Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

    Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

    Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

  • 99417.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Lindhe Söderlund, Lena
    Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institute, Sweden..
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.2016In: Journal of the American Academy of Audiology, ISSN 2157-3107, Vol. 27, no 8, p. 669--676Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss.

    RESEARCH DESIGN: This was a pilot randomized controlled trial.

    STUDY SAMPLE: The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users.

    INTERVENTION: A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation.

    DATA COLLECTION AND ANALYSIS: A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment.

    RESULTS: Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99).

    CONCLUSION: Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

  • 99418.
    Zarkani, Ershad
    Linköping University, Department of Management and Engineering.
    A proposed Generic Framework for Qualitative Risk Analysis Based on PMBOK2009Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
    Abstract [en]

    This thesis presents a generic framework for project managers and/or other stakeholders to assist them in qualitatively assessing and evaluating project risks. The main structure of this framework is constructed based on risk management area in PMBOK (Project Management Body of Knowledge) standard. Additionally, different best practices and methods in the field of risk management and decision making are studied and embedded in the framework. In spite of being theoretical in nature, the framework can contribute to the project risk management area developed by PMBOK, opening the possibility of further research for its verification.

  • 99419.
    Zarzo Fuertes, Luis
    Linköping University, Department of Electrical Engineering.
    OFDM PHY Layer Implementation based on the 802.11 a Standard and system performance analysis2005Independent thesis Basic level (professional degree)Student thesis
    Abstract [en]

    Wireless communication is facing one of the fastest developments of the last years in the fields of technology and computer science in the world. There are several standards that deal with it. In this work, the IEEE standard 802.11a, which deals with wireless LAN Medium Access Control (MAC) and Physical Layer (PHY) Specifications, is going to be discussed in detail.

    Taking this into consideration, PHY specifications and its environment are going to be studied.

    The work that the ISY department at the Institute of Technology of the Linköping University has proposed is to design a PHY layer implementation for WLANs, in a CPU, using MATLAB/Simulink and in a DSP processor, using Embedded Target for C6000 DSP and Code Composer Studio and, once implemented both, to perform and analyse the performance of the system under those implementations.

  • 99420.
    Zaushitsyn, Y.
    et al.
    Department of Chemical Physics, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
    Gulbinas, V.
    Institute of Physics, Savanoriu 231, LT-02300, Vilnius, Lithuania.
    Zigmantas, D.
    Department of Chemical Physics, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
    Zhang, Fengling
    Linköping University, The Institute of Technology. Linköping University, Department of Physics, Chemistry and Biology, Biomolecular and Organic Electronics.
    Inganäs, Olle
    Linköping University, The Institute of Technology. Linköping University, Department of Physics, Chemistry and Biology, Biomolecular and Organic Electronics.
    Sundstrom, V.
    Sundström, V., Department of Chemical Physics, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
    Yartsev, A.
    Department of Chemical Physics, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
    Ultrafast light-induced charge pair formation dynamics in poly[3-(2'-methoxy-5' octylphenyl)thiophene]2004In: Physical Review B. Condensed Matter and Materials Physics, ISSN 1098-0121, E-ISSN 1550-235X, Vol. 70, no 7Article in journal (Refereed)
    Abstract [en]

    Charge pair photogeneration was investigated by ultrafast absorption spectroscopy for different excitation photon energies in poly[3-(2'- methoxy-5' octylphenyl)thiophene] (POMeOPT) film with and without an external electric field. Electric field-assisted charge pair photogeneration in POMeOPT occurs from vibrationally relaxed singlet excitons during their entire lifetime and charge pair formation takes place in this manner even in the absence of an external electric field. From our data there are no indications of hot exciton dissociation to charge pairs even when a large amount of excess energy is supplied to the excitons. To explain these observations we present a model with energy transfer to low-barrier dissociation sites as a key feature.

  • 99421.
    Zavaleyev, V.
    et al.
    Koszalin University of Technology, Poland .
    Walkowicz, J.
    Koszalin University of Technology, Poland .
    Greczynski, Grzegorz
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, The Institute of Technology.
    Hultman, Lars
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, The Institute of Technology.
    Effect of substrate temperature on properties of diamond-like films deposited by combined DC impulse vacuum-arc method2013In: Surface & Coatings Technology, ISSN 0257-8972, E-ISSN 1879-3347, Vol. 236, p. 444-449Article in journal (Refereed)
    Abstract [en]

    DLC thin films have been deposited using a combined DC and high power impulse vacuum-arc process. Hardness and adhesion of the obtained films deposited at different substrate temperature were studied using nanohardness testing and the scratch tester REVETEST (R). The bonding structure of as-deposited films was analyzed by Raman scattering and X-ray photoelectron spectroscopy. The results show that the substrate temperature is one of the main parameters influencing the sp(3)-to-sp(2) ratio of carbon atom bonds in the coatings, which in turn affects the films mechanical properties. XRD analysis shows that a CrxCy interfacial layer forms at 280 degrees C. which reduces the adhesion properties of the DLC coatings. High quality DLC coatings are obtained by control of the specimen temperature below 280 degrees C using a sensor that is in direct contact with the substrate.

  • 99422.
    Zaytseva, Anna
    Linköping University, Department of Management and Engineering, Political Science.
    Standardization in Innovation Policy and the European Integration: New Concepts for the New World2011Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    This is a study of standardization in complexity. The context is innovation policy. Why do standardization and innovation go hand in hand and what does the interaction of interests between public and private actors look like in the “profile” of the standardization process? The nature of technical specifications, Lead Market Initiatives in Europe, social innovations, eco-innovations and psychological services for recruitment are the target areas of this study done in the style of Science, Technology and Society. We decrypt the codes of the expected behavior veiled in standards, the strategically selective sectoral integration of the European Internal Market, the emergence of innovation in standardized areas, the nature of the European innovation policy and the mission of each particular innovative sector. This research contains answers on how the European Union will move toward a more state-like organization bypassing the sovereignty of its member states. Standardization is a bouquet of strategic activities where each has its purpose, destination and time-framework. By studying standardization, we are able to look into the European future.

  • 99423.
    Zbikowski, Ancke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Brüggemann, Adrianus Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Zeiler, Kristin
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Ethical guidelines and the prevention of abuse in healthcare2012In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 165, no 1, p. 18-28Article, review/survey (Refereed)
    Abstract [en]

    Objective

    In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13–28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethicalguidelines consider issues that have shown to be related to the occurrence of AHC.

    Study design

    We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethicalguidelines was analysed.

    Results

    The various ethicalguidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients’ possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethicalguidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.

    Conclusion

    While staff members from different professions may share responsibility for the same patient, their ethicalguidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethicalguidelines in healthcare should be revised following empirical research on ethical conduct. As ethicalguidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethicalguidelines in general and regarding AHC in particular. Being aware that ethicalguidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.

  • 99424.
    Zbikowski, Anke
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Abuse in Swedish health care: Do ethical guidelines contribute theoretically to its prevention? in JOURNAL OF PSYCHOSOMATIC OBSTETRICS AND GYNECOLOGY, vol 31, issue , pp 54-542010In: JOURNAL OF PSYCHOSOMATIC OBSTETRICS AND GYNECOLOGY, Informa Healthcare , 2010, Vol. 31, p. 54-54Conference paper (Refereed)
    Abstract [en]

    n/a

  • 99425.
    Zbikowski, Anke
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Counteracting Abuse in Health Care from a Staff Perspective: Ethical Aspects and Practical Implications2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Abuse of patients by health care staff (AHC) is a cause of unnecessary suffering, which is inconsonant with the premise in medicine of not doing harm to the patient. The understanding of AHC in this thesis is considered two-dimensional: as a patient’s subjective experience and as violation of a patient’s dignity. Patients’ experiences of these events are rather well studied and are characterized by feelings of neglect and a loss of their human value. However, little is known about staff’s perspectives on AHC and what they can do to counteract it.

    Aim: The overall aim of this thesis is to approach AHC from the perspective of health care staff in order to develop and test a model for enabling health care staff to recognize and take action in situations where AHC is about to happen and to handle it professionally once it has happened.

    Methods: To explore professionals’ formal perspectives on AHC, five sets of ethical guidelines for staff working within gynecology and obstetrics were examined in study I, using an analytical framework based on empirical studies regarding issues related to AHC. Data for studies II and III were collected at a women’s clinic that had chosen to host an intervention model based on Forum Play (FP) as a method for counteracting AHC. In FP, an improvisational theater method, based on Boal’s Forum Theater, staff together stage problematic situations from their own experience and test different ways of acting. In study II, qualitative interviews with 21 staff members from the target clinic were conducted, to capture the staff’s perception of AHC before the intervention. Study III evaluated the impact of 16 FP workshops by means of questionnaires focusing on the occurrences of AHC and the perceived effects of FP, sent to all staff (n=137) before, during, and after the intervention. In study IV, ten participants of an FP course, consisting of a mixed group of employees working within health care, were interviewed about their experiences of the FP course.

    Results: In study I, it was shown that all guidelines failed to address issues related to AHC, mainly structural issues such as power imbalances between professionals. In study II, the staff’s described perception of AHC was best categorized as ethical lapses, integrating theoretical descriptions of AHC with a defensive staff-centered position that rejected responsibility for AHC. In study III, no indication of an increased awareness of AHC was found, but an increase in the staff’s ability to act in situations with a moral dilemma was confirmed, even one year after the intervention. The findings of study IV suggest that FP has the potential to develop a response ability, enabling staff to become active in AHC situations. The power to intervene when witnessing AHC was emphasized.

    Conclusions: Assuming that clinical practice is a moral activity with the good of the patient as its end, it is important for staff to be able to understand AHC from the patient’s perspective. To accomplish this, even structural aspects such as power imbalances between professionals have to be considered. By failing to address these important aspects, ethical guidelines appear to be a limited resource for helping to counteract AHC. FP enables staff participants to adopt a patient’s perspective and to develop an understanding of their power and responsibility to act when in a situation involving AHC. Furthermore FP seems to provide a useful tool for staff learning to display and overcome structural obstacles in order to intervene when witnessing AHC. If counteracting AHC is understood as a matter of acting professionally, practical training such as FP needs to be prioritized.

    List of papers
    1. Ethical guidelines and the prevention of abuse in healthcare
    Open this publication in new window or tab >>Ethical guidelines and the prevention of abuse in healthcare
    Show others...
    2012 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 165, no 1, p. 18-28Article, review/survey (Refereed) Published
    Abstract [en]

    Objective

    In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13–28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethicalguidelines consider issues that have shown to be related to the occurrence of AHC.

    Study design

    We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethicalguidelines was analysed.

    Results

    The various ethicalguidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients’ possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethicalguidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.

    Conclusion

    While staff members from different professions may share responsibility for the same patient, their ethicalguidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethicalguidelines in healthcare should be revised following empirical research on ethical conduct. As ethicalguidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethicalguidelines in general and regarding AHC in particular. Being aware that ethicalguidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    Keywords
    Abuse in health care; Quality of care; Patient safety; Ethicalguidelines; Virtue ethics
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81881 (URN)10.1016/j.ejogrb.2012.07.018 (DOI)000311762800003 ()
    Available from: 2012-09-24 Created: 2012-09-24 Last updated: 2018-11-15
    2. Ethical lapses: staff's perception of abuse in health care
    Open this publication in new window or tab >>Ethical lapses: staff's perception of abuse in health care
    2010 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 31, no 3, p. 123-129Article in journal (Refereed) Published
    Abstract [en]

    Objective. Studies have shown high lifetime prevalence of abuse in health care (AHC) in Nordic gynaecological patients. For patients AHC implies feeling disempowered, dehumanised and devalued. The aim of our study was to apprehend health care staffs perceptions of AHC. Study design. Qualitative interviews with staff at a Swedish gynaecological clinic analysed by Constant comparative analysis (N = 21). Results. The two categories - ethical failures against a patient and staff members avoid responsibility - gives two disparate pictures of what AHC is. The interviews showed that these pictures can exist alongside even if they contradict each other. The core category ethical lapses brings staffs contradictory reflections on AHC together in one picture. Notable is that the dualistic notion of AHC did not result in a moral conflict within staff members. Conclusion. Health care staff perceives AHC primarily as ethical lapses. Avoiding responsibility for AHC might lead to a failing recognition of AHC, implying that the problem is not properly dealt with. Our study highlights the need for a more open attitude in health care staff toward AHC. To counteract AHC, staff members need to accept that AHC occurs also in their own units, bringing in moral conflicts in the everyday work.

    Keywords
    Education, qualitative methods
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58823 (URN)10.3109/0167482X.2010.491169 (DOI)
    Available from: 2010-08-27 Created: 2010-08-27 Last updated: 2018-11-15
    3. Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff
    Open this publication in new window or tab >>Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: In their lifetime, 13%–28% of female patients in the Nordic countries seeking gynecological health care have reported abuse by staff in a health care setting (AHC). Besides suffering, AHC can cause patients to avoid contacting the health care system. Thus, interventions are clearly needed. In this article, we report a drama intervention method among health care staff and study to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it.

    Design: Pre-/post-test measurement by means of self-reported questionnaires with a longterm follow-up one year after the intervention. Questionnaires were distributed at four measuring times.

    Setting: A women’s clinic in Sweden.

    Participants: All staff at the target clinic were invited to participate in the intervention and received the questionnaires (n=137). Of those 136 had the possibility to participate in the intervention. A total of 92 staff members (67%) returned at least two questionnaires. 76 (56%) participated in the intervention, of which 61 (80%) returned at least one questionnaire.

    Intervention: The drama intervention was based on Forum Play (FP), a form of improvised role-play based on the pedagogy of Augusto Boal. During one year, 2008–2009, 16 half-day FP workshops focusing on AHC were conducted at the target clinic. Participation was voluntary.

    Primary outcome measures: 1) The number of reported occasions when staff heard of or were involved in AHC. 2) FP participants’ self-reported ability to act in AHC-related situations.

    Results: No change could be seen in the number of occasions of AHC reported by staff between baseline and one year after the intervention. However, an increase of the participants’ ability to act in AHC-related situations was seen.

    Conclusions: Health care staff’s participation in FP workshops can increase their ability to take action in AHC situations, but probably does not affect their awareness of AHC.

    Keywords
    Abuse in health care, interactive theater, Forum Play, Forum Theater, health care staff, professional-patient relation, moral resources
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-106232 (URN)
    Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2018-11-15Bibliographically approved
    4. Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff
    Open this publication in new window or tab >>Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff
    2016 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, p. 9-18Article in journal (Refereed) Published
    Abstract [en]

    Background: In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

    Method: Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

    Results: The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

    Conclusion: The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

    Place, publisher, year, edition, pages
    Sage Publications, 2016
    Keywords
    Abuse in health care, professional-patient relation, health care, power, Forum Theater, Forum Play, constant comparative method, ethical learning
    National Category
    Medical Ethics
    Identifiers
    urn:nbn:se:liu:diva-106233 (URN)10.1177/1477750915622032 (DOI)
    Note

    At the time for thesis presentation publication was in status: Manuscript

    At the time for thesis presentation manuscript was named: Forum Play as a Method for Ethical Learning: A Qualitative Study among Swedish Health Care Staff

    Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2017-12-05Bibliographically approved
  • 99426.
    Zbikowski, Anke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Brüggemann, A. Jelmer
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Counteracting Abuse in Health Care: A Quantitative Evaluation of an Intervention with Forum Play for Staff2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: In their lifetime, 13%–28% of female patients in the Nordic countries seeking gynecological health care have reported abuse by staff in a health care setting (AHC). Besides suffering, AHC can cause patients to avoid contacting the health care system. Thus, interventions are clearly needed. In this article, we report a drama intervention method among health care staff and study to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it.

    Design: Pre-/post-test measurement by means of self-reported questionnaires with a longterm follow-up one year after the intervention. Questionnaires were distributed at four measuring times.

    Setting: A women’s clinic in Sweden.

    Participants: All staff at the target clinic were invited to participate in the intervention and received the questionnaires (n=137). Of those 136 had the possibility to participate in the intervention. A total of 92 staff members (67%) returned at least two questionnaires. 76 (56%) participated in the intervention, of which 61 (80%) returned at least one questionnaire.

    Intervention: The drama intervention was based on Forum Play (FP), a form of improvised role-play based on the pedagogy of Augusto Boal. During one year, 2008–2009, 16 half-day FP workshops focusing on AHC were conducted at the target clinic. Participation was voluntary.

    Primary outcome measures: 1) The number of reported occasions when staff heard of or were involved in AHC. 2) FP participants’ self-reported ability to act in AHC-related situations.

    Results: No change could be seen in the number of occasions of AHC reported by staff between baseline and one year after the intervention. However, an increase of the participants’ ability to act in AHC-related situations was seen.

    Conclusions: Health care staff’s participation in FP workshops can increase their ability to take action in AHC situations, but probably does not affect their awareness of AHC.

  • 99427.
    Zbikowski, Anke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department for Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden .
    Zeiler, Kristin
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden .
    Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff2016In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Background: In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

    Method: Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

    Results: The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

    Conclusion: The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

  • 99428.
    Zbornikova, V.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Long term follow-up of unilateral occlusion of the internal carotid artery including repeated tests of vasomotor reactivity by transcranial Doppler2006In: Neurological Research, ISSN 0161-6412, E-ISSN 1743-1328, Vol. 28, no 2, p. 220-224Article in journal (Refereed)
    Abstract [en]

    Background: Early study on pathological flow pattern in the ophthalmic artery (OA), connected with impaired vasomotor reactivity (VMR) ana low pulsatility index (PI) in the anterior cerebral artery (ACA) on the occluded side, suggested collateral exhaustion. We undertook this study to evaluate whether the occurence of new strokes is predicted by special haemodynamic features. Method: A total of 27 patients (22 men and five women), aged 63 ± 15 years (mean ± SD) with longstanding occlusion of the internal carotid artery (ICA), confirmed by duplex scanning were studied. They had minimal neurological deficit and were followed-up for mean 4.3 ± 1.8 (mean ± SD) years by repeated clinical and 3-D transcranial Doppler (3-D TCD) examinations with azetazolamide test of vasomotor reactivity (VMR). Results: During follow-up, seven patients had new strokes (five minor strokes and two major ones), two ipsilateral and four contralateral to the ICA occlusion and one in the posterior circulation. Four patients died, All patients experiencing a new stroke had previous symptoms and pathological flow patterns in the OA, Le retrograde or isoelectric flow were noted in six of them. One patient with contralateral stroke experienced occlusion of the ICA located above the origin of the OA with anterograde flow, otherwise none of 11 patients with anterograde flow had a new stroke (p<0.05, Fisher exact text). During the follow-up, the initial mean velocity (MV) in the middle cerebral artery (MCA) on the occluded side in six patients with a new stroke in the anterior circulation, was 26.83 ± 10.50 cm/s, which was significantly different from that of patients without a new stroke (45.80 ± 12.8 cm/s) (p<0.01). MV in the ICA on the non-occluded side at the last examination was greater than that at the first examination (p<0.05) and increased after the use of acetazolamide only on this side (p<0.05), while PI decreased bilateraly (p<0.001 and 0.05). Resting MV both in the MCA on the occluded and ACA on the non-occluded side slightly decreased, while MV in the posterior cerebral artery (PCA) increased on the occluded siae (p<0.083) compared with that at the start of the follow-up. VMR in the ACA decreased slightly both on the non-occluded and occluded side (?-6.9 and ?-5.3 respectively), while impaired VMR = 77% was not significantly connected with new strokes. Conclusion: During the follow up, new strokes had appeared on both sides and in vertebrobasilar territory and were connected with pathological flow pattern in the OA and low MV in the MCA at the first examination. © 2006 W. S. Maney & Son Ltd.

  • 99429.
    Zdilar, Daniel
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Elevers inställning till de naturvetenskapliga ämnena: en enkätstudie med elever i årskurs 92015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Ett problem som jag såg när jag var ute på praktik var hur elevernas intresse och inställning till de naturvetenskapliga ämnena för vissa elever är negativa vilket leder till att de inte vill arbeta med ämnena. Tidigare forskning visar att detta intresse och inställning hos barn och ungdomar sjunker med de stigande åldrarna. Syftet med detta examensarbete är att undersöka vilken inställning som eleverna har till de naturvetenskapliga ämnena som undervisas i den svenska skolan. Utöver detta undersöks även vilka åsikter som dessa elever har till vad som ska göras för att de ska få en positiv inställning till dessa ämnen. Denna undersökning genomfördes med en kvantitativ enkätstudie hos fyra klasser med elever i årskurs 9 vid en kommunal skola. Resultatet ifrån examensarbetet är att inställningarna skiljer såg åt mellan eleverna. Det fanns moment inom varje ämne som de hade en positiv och en negativ inställning till, medan vissa inte svarade eller var helt negativt inställd till ämnet i helhet. Eleverna anser att det ska ändras i undervisningsformen för att de ska få en positiv inställning till dessa ämnen, genom att ha fler diskussioner och komma bort ifrån böckerna, ha mer praktiska lektioner och arbeta i ett lugnare tempo.

  • 99430.
    Zdolsek, Hans Joachim
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    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
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Non-invasive assessment of fluid volume status in the interstitium after haemodialysis2000In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, no 2, p. 211-220Article in journal (Refereed)
    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.

  • 99431.
    Zdolsek, Hans Joachim
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Lindahl, Olof Anton
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Ängquist, Karl-Axel
    Department of Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Non-invasive assessment of intercompartmental fluid shifts in burn victims1998In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 24, no 3, p. 233-240Article in journal (Refereed)
    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.

  • 99432.
    Zdolsek, Hans Joachim
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Lisander, Björn
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Jones, Wayne A.
    The National Laboratory of Forensic Chemistry, University Hospital, Linköping, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans2001In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, no 5, p. 844-852Article in journal (Refereed)
    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.

  • 99433.
    Zdolsek, Hans Joachim
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Lisander, Björn
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    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 liver1999In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 27, no 12, p. 2622-2625Article in journal (Refereed)
    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.

  • 99434.
    Zdolsek, Helena
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Janefjord, Camilla
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Reduced IL-2-induced IL-12 responsiveness in atopic children2003In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 14, no 5, p. 351-357Article in journal (Refereed)
    Abstract [en]

    Atopy may be associated with a reduced T-cell function particularly regarding maturation of T helper 1 (Th1) responses. We hypothesized that atopic children may have a reduced capacity to up-regulate the β2 subunit of the interleukin-12 (IL-12) receptor (IL-12Rβ2, the signal-transducing component). The study included 38 children followed from birth to the age of 7 years. Twenty one had a cumulative history of atopic disease, whereas 17 had none. Sixteen out of 21 children also had atopic symptoms within the past year (current), out of whom 10 children had atopic airway symptoms. The expression of IL-12Rβ2 mRNA was analyzed by quantitative real-time PCR and the secretion of interferon-γ (IFN-γ), IL-5 and IL-10 was assessed by enzyme-linked immunosorbent assay (ELISA). Children with current atopic airway symptoms and high levels of total IgE up-regulated IL-12Rβ2 mRNA expression less than non-atopic children with low IgE levels after IL-2 stimulation. This was accompanied by a low IL-2- and IL-12-induced IFN-γ production, possibly reflecting the reduced capacity of atopic children to up-regulate the IL-12 receptor. As IL-2 is needed to initiate and sustain immune responses and IL-12 promotes Th1 responses, this may contribute to the Th2-skewed pattern in atopic children.

  • 99435.
    Zdolsek, Helena
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Expression of the T-cell markers CD2 and CD28 in healthy and atopic children during the first 18 months of life2003In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 14, no 3, p. 169-177Article in journal (Refereed)
    Abstract [en]

    Atopy may be associated with a reduced T-cell function early in life, particularly regarding maturation of Th1 responses. The T-cell surface molecules CD2 and CD28 are involved in important T-cell activation pathways. Stimulation via the CD2 receptor increases the responsiveness to interleukin (IL)-12, which is a potent inducer of Th1 responses, whereas CD28 stimulation is critical for Th2 differentiation. Our aim was to prospectively study the expression of the cell-surface markers CD2 and CD28 on T-cells in relation to development of atopic disease. Children (n = 172) were followed from birth to 18 months and the cumulative history of atopic disease was recorded. Blood samples were obtained at birth and at 18 months, and in a subgroup of 78 infants also at 3, 6 and 12 months. Flow cytometry was used to analyze the T-cell markers CD2 and CD28, the latter also within the subsets of T-helper (CD4+) and T-cytotoxic (CD8+) cells. At 18 months, 31 children had and 118 did not have atopic symptoms. At this age, skin prick test (SPT) positive children with atopic symptoms with or without an atopic family history (AFH) showed a lower expression of CD2 mode fluorescence intensity (FI) as well as a lower proportion of CD2+ cells, as compared with non-sensitized children with neither atopic symptoms nor AFH. This was accompanied by a higher expression of CD28 FI on CD2+CD8+CD28+ cells. No significant differences were seen at time points before 18 months, although the proportion of CD2+ tended to be low also earlier in life. In conclusion, the observed reduced expression of CD2 in atopic infants may support previous findings that atopy is associated with a reduced CD2 function. The high CD28 FI in SPT positive children with atopic symptoms may possibly be a consequence of a TH2-skewed immune system.

  • 99436.
    Zdolsek, Helena
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Reduced levels of soluble CD14 in atopic children2004In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 34, no 4, p. 532-539Article in journal (Refereed)
    Abstract [en]

    Background A reduced microbial stimulation has been reported as a reason for the increasing prevalence of atopic diseases in industrialized countries. Antigen-presenting cells (APC), responding to microbial signals by pattern recognition receptors such as CD14, have an important role in the development of the Th1/Th2 balance.

    Objective We hypothesized that atopic children have a lower expression of CD14 on monocytes and lower soluble CD14 levels (sCD14).

    Methods Seventy-six children were followed prospectively from birth and signs of atopic disease were evaluated. The expression of CD14 on monocytes was analysed with flow cytometry at 0, 3, 6, 12 and 18 months. Circulating levels of sCD14 were analysed by ELISA and total IgE was analysed by fluoroenzymo immunoassay at these ages, and in a subgroup, followed up at 7 years.

    Results Levels of sCD14 were reduced at 7 years both in children with a current or a cumulative history of atopy compared to non-atopic children with P=0.002 and 0.001, respectively. Sensitized children with atopic symptoms had lower sCD14 at 3 and 18 months and at 7 years of age than non-atopic non-sensitized children with P=0.023, 0.039 and 0.008, respectively.

    Conclusion The lower levels of sCD14 observed in atopic children may be a consequence of an atopic family heredity and/or atopic disease, but it may also reflect a reduced capacity to respond to microbial signals.

  • 99437.
    Zdolsek, Joachim
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Letter: Allergic reaction after dextran In response2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 1, p. 132-133Article in journal (Other academic)
    Abstract [en]

    n/a

  • 99438.
    Zdolsek, Joachim
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Water physiology in burn victims2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patients who sustain a burn injury of more than 20 - 30 % TBSA will, if untreated, develop burn shock within a couple of hours. Flcid is lost fi·om the vascular compartment due to suction from the interstitium of the wound and due to a generalised increase in vascular permeability. To prevent bum shock intravenous fluids are given during the first two days after a bum in order to ensure adequate organ perfusion. Although organ perfusion will be improved when blood volume is restored, the fluid provided will add to the continuing leak into the tissues. With fluid treatment the patient survives the acute stage, but the resulting oedema interferes with the healing of the burn wound and partially damaged skin may be further compromised.

    To describe, follow and understand the development of the general oedema in burn injured patients we used four different techniques. Ethanol dilution was used for measurement of total body water (TBW), iohexol dilution in order to estimate extracellular volume (ECV), bioimpedance analysis (BIA) to register TBW as well as electrical membrane properties and the impression method (IM) for the measurement of visco-elastic properties in non-burned tissues. In order to further examine the non-invasive techniques (BIA and IM) these were used in patients subjected to haemodialysis.

    The excess fluid was found to be accumulated in the extracellular space. Interesting alterations in the visco-clastic properties of the skin and cellular electrical membrane properties could also be detected. These alterations were not related to the actual tluid volume in the tissues. Instead, they were related to changes in the fluid equilibrium of the tissues. Still, one week postbum an excess of tissue fluid, altered cellular electrical membrane properties and changed visco-elastic properties of the skin remained.

    Albumin supplementation did not influence the amount or distribution of the excess tissue fluid, measured with dilution techniques.

    List of papers
    1. Human postburn oedema measured with the impression method
    Open this publication in new window or tab >>Human postburn oedema measured with the impression method
    1993 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 19, no 6, p. 479-489Article in journal (Refereed) Published
    Abstract [en]

    The course of tissue swelling in human non-injured skin after burn injury was investigated with a non-invasive impression method that measures force and tissue fluid translocation during mechanical compression of the skin. Time-dependent changes in the fluid translocation and the interstitial-pressure related to impression force were measured on 11 occasions, during 3 weeks, in seven patients postburn. A mathematical model was fitted to the impression force curves and the parameters of the model depicted the time-dependent compartmental fluid shift in the postburn generalized oedema. Tissue fluid translocation increased significantly (P < 0.05) up to a maximum value after 6 days postburn and declined thereafter. This indicated a continuous increase in the generalized postburn oedema for the first 6 days postburn. Impression force at 3 weeks postburn was significantly lower (P < 0.001) as compared with the half-day postburn value, indicating an increased tissue pressure during the first days postburn. Parameter analysis indicated a flux of water-like fluid from the vasculature to the interstitial space during the first 6 days postburn. The spread of the values registered between different measurement sites was, however, large.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79563 (URN)10.1016/0305-4179(93)90003-Q (DOI)
    Available from: 2012-08-08 Created: 2012-08-08 Last updated: 2017-12-07Bibliographically approved
    2. Non-invasive assessment of intercompartmental fluid shifts in burn victims
    Open this publication in new window or tab >>Non-invasive assessment of intercompartmental fluid shifts in burn victims
    1998 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 24, no 3, p. 233-240Article in journal (Refereed) Published
    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.

    Keywords
    Biolectric impedance, Burns, Oedema, Body fluid, Extracellular fluid, Extracellular matrix
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79564 (URN)10.1016/S0305-4179(98)00016-3 (DOI)
    Available from: 2012-08-08 Created: 2012-08-08 Last updated: 2017-12-07Bibliographically approved
    3. Non-invasive assessment of fluid volume status in the interstitium after haemodialysis
    Open this publication in new window or tab >>Non-invasive assessment of fluid volume status in the interstitium after haemodialysis
    2000 (English)In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, no 2, p. 211-220Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-47661 (URN)10.1088/0967-3334/21/2/301 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    4. Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
    Open this publication in new window or tab >>Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
    2001 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, no 5, p. 844-852Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25136 (URN)10.1007/s001340100935 (DOI)9569 (Local ID)9569 (Archive number)9569 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    5. The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver
    Open this publication in new window or tab >>The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver
    1999 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 27, no 12, p. 2622-2625Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25135 (URN)9568 (Local ID)9568 (Archive number)9568 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
  • 99439.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Vrinnevi Hospital, Sweden.
    Bergek, Christian
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Sodertalje Hospital, Sweden.
    Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringers acetate and hydroxyethyl starch 130/0.42015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1303-1310Article in journal (Refereed)
    Abstract [en]

    BackgroundDuring fluid infusion therapy, plasma proteins are diluted and leak from the intravascular space, which alters the colloid osmotic pressure (COP) and potentially affects coagulation. We hypothesised that acetated Ringers and starch solution, alone or in combination, influence these mechanisms differently. Materials and methodsOn different occasions, 10 male volunteers were infused with 20ml/kg acetated Ringers and 10ml/kg 6% hyroxyethyl starch 130/0.4 (Voluven((R))) alone or in combination (first with starch solution followed by Ringers solution). Blood samples were collected every 30-min for measurements of COP, blood haemoglobin, platelets, and plasma concentrations of albumin, immunoglobulins (IgG and IgM), coagulation factor VII (FVII), fibrinogen, cystatin C, activated partial thromboplastin time (APTT) and prothrombin international normalised ratio (PT-INR). Changes were compared with the haemoglobin-derived plasma dilution. ResultsThe COP increased by 8.4% (SD 3) with starch and decreased by 26.2% (7.9) with Ringers. These infusions diluted the plasma by 23.4% (5.3) and 18.7% (4.9) respectively. The COP changes in the combined experiment followed the same pattern as the individual infusions. Albumin and IgG changes in excess of the plasma dilution were very subtle. The intravascular contents of the IgM and platelets decreased, whereas FVII, fibrinogen and cystatin C increased. PT-INR increased by 1/3 of the plasma dilution, whereas changes in APTT did not correlate with the plasma dilution. ConclusionsThe starch increased COP and only minor capillary leak occurred in healthy volunteers. The fluid-induced plasma dilution correlated with mild impairment of the extrinsic coagulation pathway but not of the intrinsic pathway.

  • 99440.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Boldt, J
    Dettori, N
    Engelhard, K
    Haljamäe, H
    Kocian, R
    Kretz, F-J
    Lisander, Björn
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Mythen, M
    Volume replacement/Joachim Boldt.2004In: Volume replacement / [ed] Joachim Boldt, Germany: UNI-MED Verlag AG , 2004, p. -116Chapter in book (Other academic)
    Abstract [en]

    "This book is not another attempt to create a ""cook book"" on volume replacement of fluid substitution. This book, in contrast, summarizes the up-to-date-knowledge of this topic presented by experts from a wide range of disciplines. Everybody caring for the critically ill will profit from the different chapters at different levels - nurses, students, residents, consultants, and even experts on volume therapy

  • 99441.
    Zdolsek, Joachim
    et al.
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Holmgren, Susanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics.
    Wedenberg, K
    Department of Obstetrics and Gynaecology, Eskilstuna, Sweden.
    Lennmarken, Claes
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child2009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 6, p. 828-829Article in journal (Refereed)
    Abstract [en]

    Circulatory arrest during pregnancy is extremely rare and there should be a well-planned strategy for its management in all hospitals. To consider the priority of the mothers life over the childs and an unwarranted pre-term delivery may lead to hesitancy and uncertainty and jeopardize both of them. In these situations, speed is a priority. Cardiopulmonary resuscitation should commence immediately. The anaesthesiologist should be well aware of the possible advantage of a caesarean section. Even if the obstetrician is responsible for the decision to perform the operation, the anaesthesiologist should strongly support the action. An emergency caesarean kit with the essential surgical instruments should be immediately available in every labour ward and emergency department.

  • 99442.
    Zdolsek, Joachim
    et al.
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Kågedal, Bertil
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Lisander, Björn
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Glomerular filtration rate is increased in burn patients2010In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 36, no 8, p. 1271-1276Article in journal (Refereed)
    Abstract [en]

    Urinary output a key parameter guiding fluid resuscitation in burn trauma is an inadequate measure of renal function In this study the clearance of iohexol (CL) was used to follow the glomerular filtration rate during the first week after burn Nineteen adults with major burns received an intravenous bolus injection of iohexol every other day Plasma concentration of iohexol was measured over 4 h and CL was calculated by a one compartment kinetic model The results were compared to the CL as obtained by a two compartment model and also to the CL measured in 10 healthy controls The results show that CL values for burn patients were high The first day after burn median CL was 155 mL/min/1 73 m(2) (range 46-237) which exceeded that for the controls (mean 117 mL/min/1 73 m(2) P less than 0 01) However on day 7 the CL approached the expected baseline (mean 122 mL/min/1 73 m(2)) CL was 10% lower when calculated from two compartment kinetics and a correction factor of 0 9 was applied to all results obtained by the one compartment calculations to give results comparable to those from the two compartment kinetics In conclusion CL is increased early after burn The mechanism is unclear but it parallels the period of vascular dysfunction and increased cardiac output

  • 99443.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Li, Yuhong
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Detection of Dehydration by Using Volume Kinetics2012In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 115, no 4, p. 814-822Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients admitted to surgery may be dehydrated, which is difficult to diagnose except when it is severe (>5% Gl116 of the body weight). We hypothesized that modest dehydration can be detected by kinetic analysis of the blood hemoglobin concentration after a bolus infusion of crystalloid fluid.

    METHODS: Four series of experiments were performed on 10 conscious, healthy male volunteers. Separated by at least 2 days, they received 5 or 10 mL/kg acetated Ringer's solution over 15 minutes. Before starting half of the IV infusions, volume depletion amounting to 1.5 to 2.0 L (approximately 2% of body weight) was induced with furosemide. The elimination clearance and the half-life of the infused fluid were calculated based on blood hemoglobin over 120 minutes. The perfusion index and the pleth variability index were monitored by pulse oximetry after a change of body position.

    RESULTS: Dehydration decreased the elimination clearance of acetated Ringer's solution [median (25th-75th percentile)] from 1.84 (1.23-2.57) to 0.53 (0.41-0.79) mL/kg/min (Wilcoxon matched-pair test P < 0.001) and increased the half-life from 23 (12-37) to 76 (57-101) minutes (P < 0.001). The smaller infusion, 5 mL/kg, fully discriminated between experiments performed in the euhydrated and dehydrated states, whereas the urinary excretion provided a less-reliable indication of hydration status. Dehydration decreased the perfusion index but did not affect the pleth variability index.

    CONCLUSION: Dehydration amounting to 2% of the body weight could be detected from the elimination clearance and the half-life of an infusion of 5 mL/kg Ringer's solution.

  • 99444.
    Zdolsek, Joachim
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Resuscitation of the severely burned patient2002In: International Journal of Intensive Care, ISSN 1350-2794, Vol. 8, p. 225-231Article in journal (Refereed)
  • 99445.
    Zdolsek, Joachim
    et al.
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Lisander, Björn
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Hahn, Robert G.
    Department of Anesthesiology, Karolinska Institute, Stockholm, Sweden.
    Measuring the size of the extracellular fluid space using bromide, iohexol, and sodium dilution2005In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 101, no 6, p. 1770-1777Article in journal (Refereed)
    Abstract [en]

    There is a need to find methods to assess the size of the extracellular fluid (ECF) volume without involving radioactive tracers. For this purpose, we applied 3 methods for measuring the ECF volume in 10 male volunteers (mean age, 34 yr). Steady-state plasma bromide concentration (control) was compared to the results of kinetic analysis of plasma iohexol and to kinetic analysis of the dilution of serum sodium after IV infusion of 1 L of isotonic mannitol. The volume of distribution of these tracers was used to indicate the ECF volume. The results disclosed statistically significant correlations between the results of all 3 methods, although the average sodium dilution showed 0.7 L lower values than iohexol and 1.4 L lower than bromide. All three methods correlated significantly with body weight. The percentage of the body weight indicated by the methods was 18.3% (3.1%) for sodium, 19.6% (1.0%) for iohexol, and 20.5% (1.1%) for bromide. We conclude that sodium dilution may be performed at bedside but iohexol and bromide showed less intersubject variability. Iohexol simultaneously measures the glomerular filtration rate and should be a viable clinical option if the hospital performs routine assessments of kidney function using this tracer. ©2005 by the International Anesthesia Research Society.

  • 99446.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    Vegfors, Magnus
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Chemistry.
    Tornquist, T.
    Regional Hospital Motala.
    Bortnik, P.
    Regional Hospital Motala.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hydroxyethyl starches and dextran during hip replacement surgery: effects on blood volume and coagulation2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 6, p. 677-685Article in journal (Refereed)
    Abstract [en]

    Background: Colloid fluids influence the coagulation system by diluting the plasma and, potentially, by exerting other effects that are unique for each fluid product. We hypothesised that changes in the coagulation measured at the end of surgery would be mainly governed by differences in half-life between the colloid fluids. Methods: Eighty-four patients were randomised to receive one of four colloids: HES 130/0.42/6 : 1 (Venofundin (R)), 130/0.4/9 : 1 (Voluven (R)), 200/0.5/5 : 1 (Haes-steril (R)) and 6% dextran 70 (Macrodex (R)). Blood samples were taken just before and after a preoperative 500ml bolus, and also after subsequent elective hip replacement surgery. Volume expansion was estimated from the blood dilution and coagulation assessed by ROTEM, activated partial thromboplastin time, prothrombin international normalised ratio (PT-INR), D-dimer and thrombin-antithrombin complex (TAT). Results: The blood volume expansion amounted to approximately 600 ml for all four colloids directly after infusion. Voluven (R) and Haes-steril (R) prolonged the aPT time and Venofundin (R) increased TAT. Although all colloids increased PT-INR and D-dimer, the ROTEM analyses showed that they consistently shortened the clotting time and weakened the clot strength. These effects were mainly unchanged after surgery, during which the haemorrhage averaged 500-600 ml. Macrodex (R) produced a stronger volume support at the end of the surgery (91% of infused volume; Pless than0.001) than the three starch solutions (42-60%). Conclusions: All tested colloid fluids induced a mild hypercoagulable state with faster clotting, but with weaker clot strength. The additive influence of surgery was relatively small, and postoperative changes in coagulation were mainly due to differences in the half-life of each colloid.

  • 99447.
    Zdolsek, Johann
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Effects of reactive oxygen species on the cellular vacuolar apparatus1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Reactive and potentially harmful oxygen species occur, and are continuously formed, in all cells of a living organism. Increased production of these metabolites are seen in a number of pathological states, for instance in inflammatory foci or during reoxygenation of ischemic tissue. Reactive oxygen species are considered to be associated with aging, the development of cancer and atherosclerosis.

    The main aim of this study was to investigate the effects of reactive oxygen species on the cellular vacuolar apparatus, in particlar lysosomes.

    It was found that neither superoxide radicals nor hydrogen peroxide alone had any damaging effect on lysosomes. With the presence of iron and, when hydrogen peroxide is concerned, a reducing agent damage to lysosomes was detected in the form of impaired proton gradient, leakage of lysosomal enzyme and lipid peroxidation, suggesting involvement of hydroxyl radicals.

    By refining and modifying an existing cytochemical method it was also possible to detect iron at both light- and electron microscopicallevel with preserved ultrastructure. Iron was mainly found in secondary lysosomes.

    It was also found that hydrogen peroxide-toxicity to cultured cells is iron dependent and could be much reduced by deferoxamine, an iron-chelator. This drug also prevented the hydrogen peroxide-mediated loss of the lysosomal proton gradient, suggesting intralysosomal Fentonreactions with generation of hydroxyl radicals.

    Acridine orange is an acidotropic photosensitizer which mainly accumulates in lysosomes. By exposing acridine orange-loaded cultured cells to blue light reactive oxygen, found to be singlet oxygen, was generated intralysosomally. This lead to loss of the proton gradient over the lysosomal membrane and a decrease in lysosomal cathepsin activity. Inhibition of lysosomal proteases lead to a reduction in acridine orange-mediated cell death suggesting a role for these enzymes in cell death. Electron microscopy revealed bleb-formation and increased autophagocytosis in photosensitized cells.

  • 99448.
    Zdolsek, Johann
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Droog, Erik
    Thorfinn, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Lidman, Disa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Laser Doppler perfusion imaging of the radial forearm flap: A clinical study2006In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 40, no 2, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Laser Doppler perfusion imaging (LDPI) allows non-invasive assessment of blood flow in a predefined area of skin rather than at one single point. We have used LDPI to study the pattern of skin blood flow in the radial forearm flap before and after the flap has been raised. The data were collected from a consecutive series of 11 patients with cancer of the oral cavity or oropharynx in whom the radial forearm flap had been used during the reconstructive procedure. Reperfusion leads to an immediate hyperaemic response both in the flap and the surrounding skin. This hyperaemia remains for at least the first 30 minutes after reperfusion. The perfusion of the radial side of the forearm skin distal to the flap is significantly lower than that on the ulnar side after the skin island has been raised and the distal artery divided. We suggest that LDPI is useful for monitoring the perfusion of free skin flaps. © 2006 Taylor & Francis.

  • 99449.
    Zdolsek, Johann
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Eaton, J.W.
    Molecular Targets Program, Brown Cancer Center, University of Louisville, Louisville, KY 40202, United States.
    Tang, L.
    Bioengineering Department, University of Texas at Arlington, Arlington, TX 76019, United States.
    Histamine release and fibrinogen adsorption mediate acute inflammatory responses to biomaterial implants in humans2007In: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, Vol. 5Article in journal (Refereed)
    Abstract [en]

    Background: Medical implants often fail as a result of so-called foreign body reactions during which inflammatory cells are recruited to implant surfaces. Despite the clinical importance of this phenomenon, the mechanisms involved in these reactions to biomedical implants in humans are not well understood. The results from animal studies suggest that both fibrinogen adsorption to the implant surface and histamine release by local mast cells are involved in biomaterial-mediated acute inflammatory responses. The purpose of this study was to test this hypothesis in humans. Methods: Thirteen male medical student volunteers (Caucasian, 21-30 years of age) were employed for this study. To assess the importance of fibrinogen adsorption, six volunteers were implanted with polyethylene teraphthalate disks pre-coated with their own (fibrinogen-containing) plasma or (fibrinogen-free) serum. To evaluate the importance of histamine, seven volunteers were implanted with uncoated disks with or without prior oral administration of histamine receptor antagonists. The acute inflammatory response was estimated 24 hours later by measuring the activities of implant-associated phagocyte-specific enzymes. Results: Plasma coated implants accumulated significantly more phagocytes than did serum coated implants and the recruited cells were predominantly macrophage/monocytes. Administration of both H1 and H2 histamine receptor antagonists greatly reduced the recruitment of macrophages/monocytes and neutrophils on implant surfaces. Conclusion: In humans - as in rodents - biomaterial-mediated inflammatory responses involve at least two crucial events: histamine-mediated phagocyte recruitment and phagocyte accumulation on implant surfaces engendered by spontaneously adsorbed host fibrinogen. Based on these results, we conclude that reducing fibrinogen:surface interactions should enhance biocompatibility and that administration of histamine receptor antagonists prior to, and shortly after, medical device implantation should improve the functionality and longevity of medical implants. © 2007 Zdolsek et al, licensee BioMed Central Ltd.

  • 99450.
    Zdolsek, Johann
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Enebog, J.
    Wallon, Conny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    A prospective evaluation of the PerFix® Plug technique for groin hernia repair2000In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 4, no 4, p. 311-315Conference paper (Other academic)
    Abstract [en]

    The aim of the study was to prospectively evaluate complication rates, sick-leave, recurrence rate, and chronic post-operative pain after mesh-plug hernia repair. All 385 consecutive inguinal hernias (373 patients) operated at our department with the PerFix® Plug from September 1996 to December 1997 were included in the study. Follow-up included a questionnaire 3 and 12 months after the repair. Replies to the both of these questionnaires were obtained from 363 of 373 patients (98%). All patients who either reported a lump or sensory disturbance in the operated groin were offered a clinical examination. A third questionnaire focusing on chronic post-operative pain was completed by 77 of 90 patients reporting groin pain. The recurrence rate was 2% (9/385). After 25 months (17-36 months) 38 patients (10%) still experienced inguinal pain to some degree. In 7 male patients there was either pain or discomfort during sexual activities. In a patient with poorly controlled ascites the plug was removed. Day-case surgery was performed in 86% of patients with epidural or local anaesthesia, and 64% in general- or spinal anaesthesia. Employed/self-employed patients were off work for a median of 7 days (0-65). The median time to full recovery for all patients was 20 days. Conclusion: Mesh-plug hernia repair has a reasonably low complication rate together with quick recovery in a non-specialised surgical setting. Chronic inguinal pain is, however, still present to some degree in 10% of patients after two years.

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