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Biomedical subjects

E Skogvoll

Publications and source records attributed to E Skogvoll.

17 recordsLinked to original sources
PubMed2006

Two years of continued early treatment for recent-onset schizophrenia: a randomised controlled study.

OBJECTIVE: This random-controlled study evaluated benefits derived from continued integrated biomedical and psychosocial treatment for recent-onset schizophrenia. METHOD: Fifty cases of schizophrenia of less than 2 years duration were allocated randomly to integrated or standard treatment (ST) for 2 years. ST comprised optimal pharmacotherapy and case management, while IT also included cognitive-behavioural family treatment, that incorporated skills training, cognitive-behavioural strategies for residual psychotic and non-psychotic problems and home-based crisis management. Psychopathology, functioning, hospitalisation and suicidal behaviours were assessed two monthly and a composite index, reflecting overall clinical outcome was derived. RESULTS: IC proved superior to ST in reducing negative symptoms, minor psychotic episodes and in stabilising positive symptoms, but did not reduce hospital admissions or major psychotic recurrences. The composite index showed that significantly more IC patients (53%) had excellent 2-year outcomes than ST (25%). CONCLUSION: Evidence-based treatment achieves greater clinical benefits than pharmacotherapy and case management alone for recent-onset schizophrenia.

Adolescent↗
PubMed2005

Mixed venous oxygen desaturation during early mobilization after coronary artery bypass surgery.

BACKGROUND: Early postoperative mobilization induces a marked reduction in mixed venous oxygen saturation (S(v)O(2)) after aortic valve replacement. We investigated whether a similar desaturation occurs among coronary artery bypass grafting (CABG) patients, and if the desaturation was related to the preoperative ejection fraction (EF). METHODS: Thirty-one CABG patients with a wide range in EF were included in an open observational study. We recorded hemodynamic and oxygenation variables during mobilization on postoperative day 1 and day 2 using a pulmonary artery catheter. RESULTS: Patients with an EF ranging from 24 to 87% were mobilized without clinical problems. S(v)O(2) at rest was 65.4 +/- 4.9% (mean +/- SD) on day 1 and 64.3 +/- 5.8% on day 2 (NS). During mobilization, cardiac index and oxygen delivery were reduced while oxygen consumption was increased (P-values: 0.000, 0.007 and 0.000, respectively). Consequently, oxygen extraction increased, resulting in a marked reduction in S(v)O(2)-42.9 +/- 8.3% on day 1 and 47.4 +/- 8.5% on day 2 (P = 0.025 between days). Several pre-, intra- and postoperative factors were tested as possible predictors for S(v)O(2) during mobilization. No factor contributed substantially. CONCLUSION: Patients with CABG exhibit a marked desaturation during early postoperative mobilization. Preoperative ejection fraction did not affect S(v)O(2) during exercise. The clinical consequences and underlying mechanism require further investigation.

Aged↗
PubMed2005

Helicopter transport of sick neonates: a 14-year population-based study.

BACKGROUND: The Norwegian Helicopter Emergency Medical Service (HEMS) employs anesthesiologists and paramedics who are not formally trained in neonatology to provide stabilization and transport of sick neonates. We describe neonatal transport by HEMS in central Norway and report the outcome. METHODS: Retrospective analysis of HEMS missions during the 14-year period 1988-2001. RESULTS: A total of 252 neonates were transported, indicating a prevalence of 0.90 per 100 newborn. Median response time was 42 min, on-scene stabilization time 38 min and transportation time 30 min. Median gestational age (GA) was 38 weeks and 4.8% of the neonates were <1000 g and/or <28 weeks. Main clinical problems were respiratory disease, asphyxia and malformations; 30 neonates (12%) died within 1 year. No deaths were transport-related. Tube or ventilator problems were noted in seven out of 66 transports of ventilated neonates. Other technical problems were few. Regarding ventilation, oxygenation and circulation, the clinical condition of most neonates improved during transport and the median temperature rose from 36.5 degrees C to 37.0 degrees C. Hypoglycemia (<2 mmol l(-1)) was documented in 19 missions after transport; of these, eight received a glucose infusion. Four neonates might have profited from HEMS-delivered surfactant therapy. DISCUSSION: Helicopter Emergency Medical Service in central Norway provides rapid medical assistance in a wide spectrum of neonatal problems, but more attention should be paid to proper ventilation and prevention of hypothermia and hypoglycemia.

Air Ambulances↗
PubMed2002

Epidural bupivacaine with sufentanil or fentanyl during labour: a randomized, double-blind study.

BACKGROUND AND OBJECTIVE: Epidural analgesia with bupivacaine plus either sufentanil or fentanyl is widely used during labour, but it is not clear which opioid is to be preferred. The study compared these opioids at equianalgesic doses in terms of analgesia, onset time and side-effects. METHODS: Ninety females in active labour were entered into the randomized, double-blind trial. A test dose of bupivacaine was given into the epidural space. Parturients in Group S received sufentanil 8 mL as a bolus dose, followed by an infusion at a rate of 5 mL h(-1) of a mixture containing sufentanil 1 microg mL(-1) and bupivacaine 1 mg mL(-1). Patients in Group F received fentanyl 8 mL as a bolus, followed by an infusion at 5 mL h(-1) of a solution containing fentanyl 3.5 microg mL(-1) and bupivacaine 1 mg mL(-1). Additional boluses of 5 mL were of the relevant solution were given if necessary. RESULTS: In a ratio of 1.0:3.5 (sufentanil 1 microg versus fentanyl 3.5 microg), both groups reported the same analgesia with the same onset time. The onset time to obtain 50% of the initial visual analogue score was 10 and 11 min for Groups S and F, respectively. Mean visual analogue scores in Groups S and F respectively declined from 77 and 82 before epidural blockade, to 29 and 27 during the first stage of labour, and to 69 and 59 respectively during the second stage. Overall satisfaction among parturients was high (98 and 96%), particularly during the first stage (98 and 98%), and also to a large degree during the second stage of labour (74 and 79%). Furthermore, only a few extra bolus doses were required (mean 0.9 and 1.2, Groups S and F, respectively). All the females could stand on their own, and almost all (81% Group S; 79% Group F) could walk 20 m without help. There were no serious adverse effects. Moderate side-effects occurred equally often with the possible exception of less nausea and vomiting in the fentanyl group. CONCLUSIONS: Epidural analgesia for ambulatory parturients with bupivacaine plus either sufentanil or fentanyl (ratio 1.0:3.5) provides good analgesia with a low frequency of modest side-effects. No clinical differences were found between the opioids.

Analgesia, Epidural↗
PubMed2000

Helicopter emergency medical service in out-of-hospital cardiac arrest--a 10-year population-based study.

BACKGROUND: In 1988, Norway established a countrywide, physician staffed helicopter emergency medical service (HEMS). The medical benefit remains controversial. The aim of this study was to estimate the population incidence of HEMS involvement in out-of-hospital cardiac arrest, report the patient outcome and evaluate the contribution of HEMS to survival. METHODS: We studied HEMS operations in central Norway (population 364,000) during a 10-year period (1988-1997). Missions were classified according to type and quality of intervention done by the primary care providers. HEMS witnessed cardiac arrests were not considered. Patient outcome was determined as survival to hospital discharge with cerebral performance category (CPC) score. The contribution made by HEMS in each survivor was assessed from the timing of return of spontaneous circulation (ROSC) and from subsequent need for advanced medical intervention. The relation between survival and HEMS response time was investigated by ordinal correlation. RESULTS: A total of 541 requests (14.9 per 100,000 inhabitants per year) were identified, of which 424 missions were completed. Overall survival to discharge was 36/541 (6.6%), yielding a population survival incidence of 1 per 100,000 per year. Ninety-five percent of survivors made a favourable cerebral outcome (CPC 1 or 2). General practitioners/ambulance personnel resuscitated 29 out of 36 survivors. The remainder achieved ROSC after HEMS arrival. Case by case, HEMS assistance was considered possibly important in 17 survivors. We found no relation between survival and HEMS response time (P=0.77). DISCUSSION: Survival following out-of-hospital cardiac arrest assisted by HEMS in this region is low, but not negligible. While primary care is most important, HEMS may possibly contribute to the additional survival of 0.19 to 0.46 patients per 100,000 per year. This benefit appears to be independent of HEMS response time.

Adolescent↗
PubMed2000

Mixed venous oxygen saturation during mobilization after cardiac surgery: are reflectance oximetry catheters reliable?

BACKGROUND: Oximetry catheters immediately reflect changes in mixed venous oxygen saturation (SvO2). We have used the Baxter 2-SAT system to register changes in SvO2 during early mobilizations after cardiac surgery. To assess catheter reliability, readings were compared to blood gases. METHODS: A total of 352 paired catheter and bench haemoximetry measurements were obtained at the expected highest and lowest levels of SvO2 during the mobilization procedures. The agreement between methods was explored by a Bland-Altman plot. The influence of haemoglobin (Hgb), pH, cardiac output (CO), posture, catheter identity and catheter calibration on agreement was assessed through analysis of covariance. RESULTS: Data included a substantial number of low SvO2 values, 95 paired means of SvO2 < or = 50% and 37 paired means < or = 40%. Mean oxygen saturation difference between catheter and haemoximeter readings was -1.6 +/- 5.7% (SD). Agreement between the methods depended upon the level of SvO2. At SvO2 of 65%, the two methods were virtually identical. Below 65%, the catheters increasingly underestimated the corresponding haemoximetric values by 1.5% for every 10% reduction in SvO2. Agreement was to some degree dependent on individual calibrations and catheter identity, but to a lesser extent on Hgb, CO and posture. CONCLUSION: The two methods are interchangeable for most clinical purposes. Catheter readings are, however, substantially lower than the corresponding haemoximetric measurements at low SvO2 values. Careful interpretation of the absolute values resulting from catheter measurements is recommended, especially when SvO2 readings are low.

Analysis of Variance↗
PubMed2000

A comparative experimental study evaluating the performance of surgical robots aesop and endosista.

The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.

Evaluation Studies as Topic↗
PubMed2000

Circadian distribution of oral opioid consumption in cancer patients.

Diurnal variations are reported in pain perception, potency of placebo and in the pharmacokinetics of morphine. It is not established if such diurnal variation should be reflected in the routine prescription of analgesic drugs to cancer patients. One approach for investigating this question is to study the circadian rhythm of patients' requests for analgesics. We included 40 patients with malignant disease and intolerable pain despite treatment with weak opioids. Weak opioids were stopped and the patients' pain treatment was restricted for the next 2 days to strong oral opioids (ketobemidone) given on an as-needed basis. The number and times of all ketobemidone administrations were recorded. No significant diurnal variation in use of ketobemidone was observed. A descriptive curve that interpolates between successive observations displayed only slight circadian fluctuations of opioid consumption. Thus, the data reported in this paper does not support the necessity of considering chronopharmacological factors in the routine prescription of oral opioids.

Adult↗
PubMed1999

Modeling the occurrence of cardiac arrest as a poisson process.

STUDY OBJECTIVE: A statistical model for the occurrence of cardiac arrest has not been described in the literature. Independent events occurring along the time axis may constitute a Poisson process, described by the Poisson and exponential probability distributions. This statistical model defines the probability distribution of events occurring within time intervals and enables construction of confidence intervals for the mean rate. Moreover, the probability that 2 or more events will occur close in time can be estimated from knowledge of the mean rate. We investigated whether the occurrence of cardiac arrests constitutes a Poisson process. METHODS: Time and date for cardiac arrests requiring CPR out of hospital (county population, 155,000) or in hospital (850 beds) during 5 years were analyzed. Goodness of fit was assessed by comparing the observed weekly counts of cardiac arrests and the observed time intervals between such events with the values predicted from the model. RESULTS: The Poisson parameter estimates (mean weekly rates) for out-of-hospital and in-hospital cardiac arrest were 2.02 and 1.09 events per week, respectively. There was close agreement between observed and predicted values, indicating an adequate model fit. CONCLUSION: Occurrence of cardiac arrest along the time axis constitutes a Poisson process and may be adequately modeled by the Poisson and exponential distributions. The model provides information about the nature of these events and allows for probability calculations based on the mean rate of events. Examples of such calculations are given.

Cardiopulmonary Resuscitation↗
PubMed1999

Active compression-decompression cardiopulmonary resuscitation: a population-based, prospective randomised clinical trial in out-of-hospital cardiac arrest.

Different mechanical devices have been developed to improve cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate active compression-decompression (ACD) CPR applied by Emergency Medical Service (EMS) in a defined population. The Trondheim region EMS (population 154,000) employs simultaneous paramedic and physician response. Upon decision to treat, patients with cardiac arrest of presumed cardiac origin were allocated to ACD CPR (CardioPump) or standard CPR by drawing a random number tag. Outcome in each patient was determined on a 5 point ordinal scale (no clinical improvement = 1, survival to discharge = 5). In 4 years, CPR was attempted in a total of 431 cardiac arrests, 54 patients (13%) survived to discharge; 302 patients with similar baseline characteristics were randomised. The prevalence of bystander CPR was 57% and the median call-arrival interval 9 min. By intention to treat, the mean score in the standard CPR group was 2.51 and 17/145 patients (12%) survived. The mean score in the ACD CPR group was 2.53 (P = 0.9) and 20/157 patients (13%) survived. Cerebral outcome was similar in the two groups. Among the 145 ACD patients, the technique was successfully applied in 110, found inapplicable in 35 and in seven patients chest compressions were unnecessary. This is the largest, single-centre, randomised, population based study of ACD CPR in out-of-hospital cardiac arrest to date. Even when considering a wider outcome spectrum than crude survival, we found no evidence of clinical benefit. In a quarter of cases ACD CPR was inapplicable, further limiting its potential usefulness.

Aged↗
PubMed1999

In-hospital cardiopulmonary resuscitation. 5 years' incidence and survival according to the Utstein template.

BACKGROUND: Direct comparison of survival rates from in-hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in-hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material. METHODS: The hospital (900 beds, 37,000 annual admissions) has no established do-not-resuscitate (DNR) order policy. CPR outside the Intensive- or Coronary Care Units (ICU/CCU) is performed by an emergency medical team consisting of an anaesthesiologist, a medical resident and a nurse anaesthetist. CPR attempts during 5 years (1990-1994) were analysed retrospectively. Patient survival, cerebral and overall performance category (CPC/OPC) score of the survivors was determined. The Utstein template was evaluated in terms of clinical relevance and data availability. RESULTS: During 5 years, 4927 patients died as in-patients. CPR outside the CCU/ICU was attempted 244 times. CPR was primarily successful on 83 occasions (34%), and 42 patients (17%) were finally discharged with CPC 1 or 2. Survival from primary ventricular fibrillation (VF) or ventricular tachycardia was 40%, pulseless electrical activity 3%, asystole 11% and of rhythm undetermined 6%. Age or sex effects were not observed. CONCLUSION: More than 90% of in-hospital deaths in this hospital are handled without CPR being initiated. Overall survival was 17%, and almost all survivors made a favourable outcome. The Utstein template for in-hospital cardiac arrest performed acceptably as a framework for reporting outcome in this retrospective study.

Adolescent↗
PubMed1999

Out-of-hospital cardiopulmonary resuscitation: a population-based Norwegian study of incidence and survival.

The Trondheim region's (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. Information on the patient's pre-morbid conditions and final outcome was obtained from hospital records. The incidence of cardiac arrest and CPR from all causes was 68 per 100,000 per year, with 83% primary cardiac aetiology. The median alarm to patient arrival interval for ambulance and emergency physician was 8 minutes and 11 minutes, respectively. The presenting rhythm was ventricular fibrillation or tachycardia in 51%, asystole in 34%, pulseless electrical activity in 8% and undetermined in 8%. Definite return of spontaneous circulation occurred in 211 patients (40%, 27 per 100,000 per year) and 57 patients (11%, 7.4 per 100,000 per year) survived to discharge. Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.

Aged↗
PubMed1997

Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) compared with standard CPR in a manikin model--decompression force, compression rate, depth and duration.

During active compression-decompression cardiopulmonary resuscitation (ACD-CPR), the rescuer applies traction to the chest between compressions. Under experimental conditions, cardiac output increases, possibly through accentuated intrathoracal pressure fluctuations. ACD-CPR requires specific training and may be more complex to perform than standard CPR. The aim of this study was to characterize ACD-CPR performance compared with standard CPR by emergency care providers; in terms of decompression force, compression rate, depth and duration. Thirty-three ambulance paramedics were studied while performing standard CPR and ACD-CPR with the Ambu Cardiopump on a specially designed transducer-equipped manikin 9 months following initial training. The order of CPR performance was determined randomly by cross-over design. Performance data were recorded by a computer. The 2-min average active decompression force was 9.3 kg (interquartile range 2.5-15.3 kg) and six subjects (18%) met the manufacturers recommendation of 10-15 kg. External chest compression (ECC) rate decreased from 85 (70-101) to 76 (63-88) min-1 (P < 0.001), ECC depth decreased from 54 (50-58) to 45 (39-48) mm (P < 0.001) and compression duration from 40 (35-45) to 31% (28-33%) (P < 0.001) upon change from standard CPR to ACD-CPR. We conclude that the recommended level of decompression force was achieved by less than one fifth of study subjects. ACD-CPR when compared with standard CPR causes a consistent and significant reduction of compression rate, depth and duration. These are all factors of possible clinical significance. Training in ACD-CPR should address this issue, with special emphasis on optimal decompression force and ECC rate.

Adult↗
PubMed1989

[Anaphylactic shock caused by suxamethonium (Curacit)].

We describe five cases of anaphylactic shock following the short-acting muscle relaxant succinylcholine (suxamethonium). All the patients recovered uneventfully. Skin prick testing identified succinylcholine as the probable causative agent in four cases. The incidence of anaphylaxis to succinylcholine in our material appears to be 1:1,000. Treatment consisted of volume substitution, adequate oxygenation and adrenergic agents. We discuss the routine use of succinylcholine for intubation in elective surgery, and conclude that the anaesthesiologist must always be prepared for a possible anaphylactic reaction.

Adult↗