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E Eide

Publications and source records attributed to E Eide.

14 recordsLinked to original sources
PubMed2001

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes.

INTRODUCTION: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study. METHOD: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out. RESULTS: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of short-acting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening. CONCLUSION: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.

Aged↗
PubMed2000

Nuclear entry of the circadian regulator mPER1 is controlled by mammalian casein kinase I epsilon.

The molecular oscillator that keeps circadian time is generated by a negative feedback loop. Nuclear entry of circadian regulatory proteins that inhibit transcription from E-box-containing promoters appears to be a critical component of this loop in both Drosophila and mammals. The Drosophila double-time gene product, a casein kinase I epsilon (CKIepsilon) homolog, has been reported to interact with dPER and regulate circadian cycle length. We find that mammalian CKIepsilon binds to and phosphorylates the murine circadian regulator mPER1. Unlike both dPER and mPER2, mPER1 expressed alone in HEK 293 cells is predominantly a nuclear protein. Two distinct mechanisms appear to retard mPER1 nuclear entry. First, coexpression of mPER2 leads to mPER1-mPER2 heterodimer formation and cytoplasmic colocalization. Second, coexpression of CKIepsilon leads to masking of the mPER1 nuclear localization signal and phosphorylation-dependent cytoplasmic retention of both proteins. CKIepsilon may regulate mammalian circadian rhythm by controlling the rate at which mPER1 enters the nucleus.

Amino Acid Sequence↗
PubMed1998

Use of hypnotics among patients in geriatric institutions.

A survey of hypnotic use in geriatric institutions outside hospitals was performed in the county of Hordaland, Norway. The data were obtained from the cardex system in 67 institutions and represented administration of hypnotics to the patients on 3 separate days within a week. About 24% of 2802 patients in the institutions used hypnotics. The number of patients treated with hypnotics, the doses administrated and the time of administration were similar for weekends and workdays. About 98% of the hypnotics were used as scheduled, and 41% of the doses administrated were higher than the recommended lowest dose for elderly patients. Long-acting benzodiazepines constituted about 62% of the hypnotics. A significantly higher proportion of patients in old age homes used hypnotics compared to patients in nursing homes (30.7% versus 22.9%, respectively, p < 0.01). Furthermore, higher doses, administration later in the evening and use of additional hypnotics were more common in old age homes compared to nursing homes. The results indicate a need for frequent reevaluation of prescribing of hypnotics in geriatric institutions.

Aged↗
PubMed1997

Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Organisation of the treatment, effects and side-effects in 2000 consecutive patients.

BACKGROUND: There was an obvious need to improve the quality and safety of our postoperative pain treatment and to introduce an improved routine service on surgical wards. METHODS: It was decided to use postoperative epidural infusion of morphine 0.04 mg/ml and bupivacaine 2.5 mg/ml (0.25%) 4-8 ml/h as pain relief after major surgery. An education programme was run emphasising the benefits, side-effects and the importance of regular monitoring of pain intensity, vital functions (respiratory rate, blood pressure, heart rate), motor function of the legs and the need for additional drugs in order to detect side-effects as well as lack of adequate analgesic effect. A detailed observation sheet was used collecting information every 2 h throughout the epidural treatment period in order to secure monitoring and adjustment of the treatment. Close contact was maintained with the wards. RESULTS: We present a detailed analysis of our first 2000 postoperative patients, mainly after orthopaedic (46.1%), gastrointestinal (32.0%), urologic (8.7%) and vascular (8.5%) surgery. Duration of the treatment was less than 24 h in 41.4% and more than 48 h in 29.7%. Pain relief was adequate in most patients, best after vascular surgery in the lower extremities (mean VAS 0.15/10.0 (95% confidence interval 0.09-0.23)) and less after gastrointestinal (mean VAS 0.49/10 (0.43-0.54)) and thoracic surgery (mean VAS 0.59/10 (0.38-0.81)). The infusion was stopped due to respiratory depression in 3 patients (0.15%). Four (0.2%) had systolic blood pressure < 80 mmHg and had to be treated with vasopressors. A total of 56 (2.8%) patients were considered to be problem patients due to excessive sedation (0.4%), hypotension (0.7%), respiratory depression (1.6%) or lower extremity paralysis (0.05%). All patients had urinary catheter until 6 h after termination of the epidural treatment. One patient had the epidural catheter accidentally placed subarachnoidally and experienced severe respiratory depression. No permanent sequelae were recorded in the postoperative patients, but 2 traumatised patients developed epidural abscesses after 3 weeks of treatment, which resulted in lower extremity paralysis. Late response to the warning signs might have contributed to the irreversible paraplegia. CONCLUSION: Our experience with this postoperative epidural analgesia regime is favourable. It has been easy to administer and monitor. Pain relief was excellent, side-effects were few and picked up by the established routines followed by the ward staff except in the 2 trauma patients who developed epidural abscesses. The staff on the surgical wards were motivated for this kind of work. Education and strict surveillance routines are mandatory in order to secure prompt action when warning signs develops (e.g. lower limb paralysis).

Analgesia, Epidural↗
PubMed1994

Activation of the complement system and adverse effects of biodegradable pins of polylactic acid (Biofix) in osteochondritis dissecans.

Biodegradable pins of polyglycolic acid (PGA) or polylactic acid (PLA) have been used in the treatment of fractures and osteotomies during the past 5 years. Adverse effects reported have included swelling at the implantation site and sinus formation, considered to represent nonspecific foreign-body reactions. Recent reports, however, have shown severe reactions after intraarticular fracture fixation. Reactions in 2 patients, treated with polylactic pins for osteochondritis dissecans (OCD) in our hospital, prompted the present clinical investigation and further evaluation of the complement-activating potential of polylactic pins. 10 knees underwent arthroscopic fixation of an OCD-lesion with Biofix (PLA) pins. Clinical follow-ups were carried out at 2, 6, and 12 weeks and at 6 and 12 months. Blood samples were collected from 5 patients 9-24 months postoperatively for biocompatibility tests. Quantification of human C5a des Arg was performed with a recently developed sandwich ELISA technique, using neoepitope-specific monoclonal antibodies. 6 knees developed diffuse swelling and a prolonged postoperative course. 2 patients had a particularly prolonged course which could not be attributed to infection. Levels of C5a des Arg in plasma incubated in the presence of polylactic acid were higher than in plasma incubated in the absence of PLA. The high frequency of long-term postoperative inflammatory signs in these knees treated for OCD and the demonstration of a complement activation potential of PLA pins warrant further studies on the biocompatibility of this material. Until more information is available, we do not recommend intraarticular use of PLA pins.

Adolescent↗
PubMed1993

Depolarization of group II muscle afferents by stimuli applied in the locus coeruleus and raphe nuclei of the cat.

1. Electrical stimuli applied in the locus coeruleus/subcoeruleus (LC/SC) and raphe nuclei produce a profound depression of transmission in reflex pathways from group II muscle afferents. The present experiments were performed to determine whether presynaptic inhibitory mechanisms contribute to these effects. 2. Changes in the excitability of afferent terminals to electrical stimuli have been used as an indication of primary afferent depolarization (PAD) produced by conditioning stimuli applied within the LC/SC and raphe nuclei and, for comparison, in the nucleus ruber. Group II afferents originating from ankle flexor muscles and terminating in the midlumbar segments were used for testing. 3. Clear changes in excitability were observed in fourteen of nineteen group II fibres in which the effects of conditioning stimuli applied in the LC/SC were tested and in twelve of seventeen fibres in which the effects of stimuli applied within the raphe nuclei were tested. By comparison, only one of the twelve fibres tested with conditioning stimuli applied to the nucleus ruber was found to be influenced. These effects matched those of the same conditioning stimuli on field potentials evoked by group II afferents at the location at which the terminals of group II fibres were stimulated. 4. Stimuli applied in the LC/SC and in the raphe nuclei both produced a mean decrease in threshold stimulus current of 19%. These effects are comparable to those produced by the most effective volleys in peripheral afferent which, in the same fibres, produced a mean decrease in threshold stimulus current of 24%. 5. In all cases (twelve) in which the effects of stimuli applied in the LC/SC and raphe nuclei were tested on the same group II fibre, either both or neither were found to be effective. This strengthens previous indications that some populations of neurones might be activated by stimuli applied in each of these regions of the brain. 6. In contrast to group II afferents, group Ia afferents investigated in the same experiments were only exceptionally affected. Of seven fibres tested with stimuli applied in the LC/SC, six with stimuli applied in the raphe nuclei and seven with stimuli applied in the nucleus ruber, only one fibre showed any clear change in threshold and this was a single fibre which was similarly affected by stimuli in all three sites. 7. It is concluded that presynaptic inhibitory mechanisms contribute to the depression of transmission in spinal reflex pathways from group II muscle afferents produced by stimulation in the LC/SC and raphe nuclei.

Animals↗
PubMed1985

[Use of fibrin glue in pronounced Dupuytren contracture].

In the surgical treatment of Dupuytren's disease a tissue adhesive, Tissucol (Immuno, Heidelberg), has been used rather than vacuum drainage to reduce postoperative haematoma formation. Tissucol has been used in more than 260 severe cases of Dupuytren's disease. The size of postoperative haematoma formation and the degree of necrosis of wound margins have both been significantly reduced. An earlier return to function has been observed.

Drug Combinations↗