Biomedical subjects

M Lundström

Publications and source records attributed to M Lundström.

At least 19 recordsLinked to original sources

PubMed2006

A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.

INTRODUCTION: This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture. METHODS: A randomized, controlled trial at the orthopedic and geriatric departments at Umeå University Hospital, Sweden, included 199 patients with femoral neck fracture, aged >or=70 years. RESULTS: Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group. Only one patient with dementia fell in the intervention group compared with 11 in the control group. The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group. The incidence rate ratio was 0.38 [95% confidence interval (CI): 0.20 - 0.76, p=0.006] for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among patients with dementia. There were no new fractures in the intervention group but four in the control group. CONCLUSION: A team applying comprehensive geriatric assessment and rehabilitation, including prevention, detection, and treatment of fall risk factors, can successfully prevent inpatient falls and injuries, even in patients with dementia.

Accidental Falls↗

PubMed2005

Duration of self assessed benefit of cataract extraction: a long term study.

AIM: To investigate how long patients' improved visual function lasts after a cataract extraction. METHODS: Patients' self assessed visual function was evaluated using the Catquest questionnaire both before and 6 months after a cataract extraction. The study population consisted of 615 patients undergoing a cataract extraction during 1995-2002. A final follow up with a new questionnaire was performed in 2003, between 1 year and 8 years after surgery. RESULTS: 445 (72.4%) patients were alive at follow up and agreed to participate in the study. The number of subjects still showing improved visual function after surgery decreased with longer follow up. After 7 years, 80% had improved visual function compared with before surgery. 50% of all originally operated subjects were alive 7 years postoperatively and enjoyed better visual function than they had done before surgery. Ocular co-morbidity in the operated eye or self assessed poor visual function before surgery was significantly related to deteriorated visual function at follow up. CONCLUSION: The number of subjects who experienced improved visual function after a cataract extraction decreased over the course of time postoperatively. Presence of ocular co-morbidity was significantly related to worsened function.

Aged↗

PubMed2002

PCR-generated linear DNA fragments utilized as a hantavirus DNA vaccine.

The field of DNA vaccines has grown rapidly, and since most such vaccines involve the inoculation of large circular DNA molecules previously propagated in bacteria, several inconveniences (e.g. the presence of antibiotic resistance genes, impurities from bacterial cultures or inefficient uptake of the large and bulky plasmid DNA molecules to the nucleus) are debated. In this study, we have explored the possibility of using smaller and more flexible PCR-generated linear DNA fragments instead. Phosphorothioate (PTO)-modified primers were used successfully to protect the PCR-generated DNA fragments from exonuclease degradation, and by using a nuclear localization signal-peptide to target the linear DNA to the nucleus the immune response against the encoded antigen was further improved. This approach was tested in cell culture using a sensitive reporter system and in vivo with DNA encoding the amino-terminus of the Puumala hantavirus nucleocapsid protein. Our results indicate that linear DNA fragments have a great potential as a genetic vaccine and phosphorothioate modification in combination with a nuclear localization signal peptide increase the stability and targets the linear DNA molecules to the nucleus resulting in an improved biological response examined both in vitro and in vivo.

Animals↗

PubMed2002

Cataract surgery and quality of life in patients with age related macular degeneration.

BACKGROUND: The coexistence of cataract and age related macular degeneration (AMD) is not unusual, especially in the very elderly. The outcome of cataract surgery in these cases depends on the effect of AMD on vision. In this study the authors have compared the outcome of cataract patients with AMD to that of cataract patients with no vision threatening ocular comorbidity, and analysed possible predictors of good or poor outcome. METHODS: An observational prospective study on consecutive cases operated for cataract during 1 month at six surgical departments affiliated to the Swedish National Cataract Register (NCR). Data were collected according to the protocol of NCR and subjects completed the Catquest questionnaire before and 6 months after surgery. 90 subjects with AMD were compared to 335 subjects with no sight threatening ocular comorbidity. RESULTS: Difficulties in performing various daily life activities improved significantly for AMD subjects after surgery (p<0.001, Wilcoxon signed rank test). Satisfaction with vision also improved significantly after surgery (p<0.001, Wilcoxon signed rank test). Activity level and independence were unchanged. Subjects with no ocular comorbidity had a still better outcome. The most important variable related to a good self assessed functional outcome was postoperative visual acuity irrespective of the presence of AMD. AMD subjects scheduled for second eye surgery and AMD subjects dissatisfied with their vision before surgery had a poorer outcome. CONCLUSION: Subjects with various stages of dry AMD and cataract improved their self assessed visual function and satisfaction with vision significantly after cataract extraction.

Activities of Daily Living↗

PubMed2001

1998 European Cataract Outcome Study: report from the European Cataract Outcome Study Group.

PURPOSE: To collect clinical data on cataract surgery to allow participating surgeons to compare their performance with that of their colleagues in an anonymous manner. SETTING: Surgeons from 31 surgical units providing cataract surgery in 13 European countries. METHODS: Every patient at each participating unit having surgery during 1 study month was evaluated. Data were reported to the coordinating center at the time of surgery and at the final examination. When the study was closed 6 months after surgery, all participants were provided with the outcomes from their own patients so they could compare them with outcomes from other centers. RESULTS: The study included preoperative and intraoperative data on 2950 patients. Complete follow-up data were available for 2731 patients. The surgical audit included surgically induced astigmatism, proximity of target refraction, and the frequency of major complications. For each variable, a large variation in outcome between participating centers was found. Most centers had results both above and below average for different variables. CONCLUSION: Cataract surgery data collected from 31 units in 13 European countries allowed participants to compare their performance with that of their colleagues in an anonymous manner. Significant variation was found in the outcomes among the units, with many units reporting results above and below the averages.

Aged↗

PubMed2001

Quality of life after first- and second-eye cataract surgery: five-year data collected by the Swedish National Cataract Register.

PURPOSE: To study the benefits of surgery and satisfaction with vision after first- and second-eye cataract surgery in comparable groups of patients. SETTING: Clinics participating in the Swedish National Cataract Outcome Study from 1995 to 1999. METHODS: A prospective observational study evaluated patients' self-assessed visual function and satisfaction with vision before and 6 months after cataract extraction. Patients who had another cataract surgery in the fellow eye during the 6-month study were excluded. Data of 8595 patients having cataract extraction at participating clinics during the month of March for 1995 to 1999 were collected. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity was recorded. The Catquest questionnaire was completed before surgery and 6 months after surgery. RESULTS: First-eye surgery was performed in 5570 patients and second-eye surgery, in 3025. Patient-assessed benefits of surgery and satisfaction with vision as defined by the Catquest was higher after second-eye surgery (P <.001). The outcomes were studied in detail in patients with equal visual acuity in the fellow eye before and after surgery and without ocular comorbidity. The better outcome after second-eye surgery was most pronounced in patients with good or intermediate visual acuity in the fellow eye. CONCLUSION: The self-assessed visual outcomes and satisfaction with vision were better after second-eye surgery than after first-eye surgery in comparable groups of patients.

Aged↗

PubMed2001

Cataract surgery and effectiveness. 2. An index approach for the measurement of output and efficiency of cataract surgery at different surgery departments.

PURPOSE: To describe a model for comparing the performance of cataract surgery among ophthalmology departments in terms of economic efficiency. METHODS: An index approach for the measurement of outcome of cataract surgery is modeled. The index approach uses information about activities and difficulties in daily life as well as visual acuity and age. The change in activities and difficulties after surgery is expressed by changes in distances, and an overall index score is calculated as ratios of values to distances. Values to distances are estimated as solutions to linear programming problems. Index scores are calculated for two groups of patients, those with an ocular co-morbidity and those without. Economic efficiency is also estimated by use of an index approach. In the estimation of efficiency we use the calculated index scores of outcome of surgery as a measure of output of the ophthalmology department. Four different departments providing cataract surgery are compared. RESULTS: The studied departments showed differences to a great extent when traditional measures of cataract surgery outcomes were used. These differences changed when the outcomes were compared by use of index scores. When economic efficiency was calculated the difference between the departments was further reduced and only one department was considered inefficient according to the model. CONCLUSION: An index approach was used to study outcomes of cataract surgery and economic efficiency in four departments. This approach takes into account the complexity of cost in relation to feasible outcome. The ranking between the departments described by traditional methods turned out differently using the model.

Cataract Extraction↗

PubMed2001

Age-related utilisation of cataract surgery in Sweden during 1992-1999. A retrospective study of cataract surgery rate in one-year age groups based on the Swedish National Cataract Register.

PURPOSE: To study the utilisation and increase of first eye cataract surgery in one-year age groups between 60 and 90 years of age during 1992-1999. METHODS: Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992-1999. The total number of living persons in each one-year age group was collected from the Year Book of Statistics in Sweden (1993-2000). RESULTS: The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one-year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden. CONCLUSION: The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age-related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.

Age Distribution↗

PubMed2001

Gender and referral to cataract surgery in Sweden.

PURPOSE: To investigate how cataract surgery was initiated and analyse possible gender difference in referral to surgery. METHODS: Consecutive patients scheduled for first eye cataract surgery at three Swedish community-run eye departments were interviewed concerning how surgery was initiated. RESULTS: 649 patients were interviewed and 63.2% were female. The number of patients referred to surgery by an earlier contact with a health care provider was 271 (41.8%) and the remaining 378 (58.2%) patients had actively requested advice or help because of visual problems caused by cataract and without a prior regular contact. 44.7% of female patients were referred through a health care provider they visited for reasons other than cataract and the corresponding number for male patients was 36.8%. This gender difference is statistically significant at the 5% level. CONCLUSION: A health care provider that patients visited for other problems than cataract referred female patients to cataract surgery to a significantly higher degree than male patients.

Cataract Extraction↗

PubMed2001

Data reliability and structure in the Swedish National Cataract Register.

PURPOSE: A Swedish National Cataract Register was instituted in 1992, monitoring nearly all cataract operations in Sweden, and since its inception comprising about 95% of all operations. Data from a total of approximately 290 000 operations have been collected during 1992-1998. Data quality is an important factor, and we have therefore assessed the various types and frequencies of data entry errors in the material. METHODS: The medical records for all operations in five selected participating clinics were retrieved for a set month. Each data transfer step from the record to the final data base was monitored for a total of 574 operations. A total of 10 variables were recorded for each operation. RESULTS: Significant sources of error were absent in most variables. However, possibly important errors appeared in three: "date entering waiting list", "preoperative best corrected visual acuity in the operated eye", or "visual acuity in the fellow eye". There were also noteworthy variations between the five clinics, different for different parameters. Errors were predominantly prone to appear at the very first step of registration. In most cases this was due to deviations from the data collection instructions. CONCLUSIONS: The reliability is good for most values entered into the register, but it is important to ensure that data definitions are exact and adhered to. Repeated information to the involved persons on how to fill in the forms appears to be a requisite for maintaining good input quality.

Cataract↗

PubMed2001

Delirium before and after operation for femoral neck fracture.

OBJECTIVES: The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures. DESIGN: A prospective clinical assessment of patients treated for femoral neck fractures. SETTING: Department of orthopedic surgery at Umeå University Hospital, Sweden. PARTICIPANTS: One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures. MEASUREMENTS: The Organic Brain Syndrome (OBS) Scale. RESULTS: Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only. CONCLUSIONS: Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention.

Aged↗

PubMed2000

Impaired visual function after cataract surgery assessed using the Catquest questionnaire.

PURPOSE: To evaluate and explain why some patients report more difficulties performing everyday activities 6 months after a cataract extraction than they did before surgery. SETTING: Cataract surgeons from 4 departments of ophthalmology affiliated with the National Swedish Cataract Outcome Register. METHODS: Patients were recruited from those having cataract extraction during March 1995, 1996, or 1997 at the participating units. Only patients who completed Catquest questionnaires before and after surgery and were evaluated to have a "no-benefit" outcome were included. The no-benefit outcomes were analyzed by using medical records and surgeon opinions. Possible and/or probable reasons for the outcome were identified. RESULTS: Several possible and/or probable reasons were identified as a single reason or combined with other reasons. The 5 most frequent reasons were ocular co-morbidity in the operative eye, anisometropia after surgery, problems with the nonoperative eye during follow-up, low disability score sum before surgery (no difficulties), and postoperative complications. CONCLUSION: In about a third of the cases, the no-benefit outcome could probably have been avoided by better planning for both eyes; that is, both eyes should have surgery within a short time and waiting for second-eye surgery in cases with anisometropia should be avoided.

Activities of Daily Living↗

PubMed2000

Cataract surgery in the very elderly.

OBJECTIVE: To analyze the outcome of cataract extraction in patients aged 85 years and older (>/=85 group) and to compare their outcome with that of patients younger than 85 years (</=84 group). SETTING: Cataract surgeons participating in the Swedish National Cataract Outcome Study during 1995 to 1997. METHODS: A prospective observational study was performed that evaluated patients' self-assessed visual function before and 6 months after cataract extraction. Mean age of the 4819 patients having cataract extraction at participating clinics during March 1995, 1996, and 1997 with complete follow-up data was 75.6 years; 67. 5% were women. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity, refraction, and keratometry were recorded. Each study period closed 6 months after surgery. The Catquest questionnaire was completed before surgery and 6 months after surgery. RESULTS: Of those with complete data, 757 patients (15.7%) were in the >/=85 group. In this group, visual acuity in the operative eye improved in 84.3% and a visual acuity of 0.5 or better was achieved in 71.4%. A no-benefit outcome, as defined by the Catquest questionnaire, was found in 12.7% of the >/=85 group and 8.4% of the </=84 group. CONCLUSION: Elderly patients on average had a good outcome, although not as good as that in younger patients. Certain groups were identified as having an excellent result and others of having a high risk of an adverse outcome.

Aged↗

PubMed2000

Distribution and stability of membrane proteins in lipid membranes on solid supports.

Bacteriorhodopsin and the nicotinic acetylcholine receptor were biotinylated and reconstituted in lipidic membranes on silicon supports by fusion with proteoliposomes. The presence and distribution of the proteins were studied by binding with streptavidin. Radio-labelled streptavidin was employed for quantifying the amounts of protein remaining in the supported membranes after storage in buffer. The proteins within the membranes remained bound to the surface for weeks. The biological activity of reconstituted unlabelled receptor upon storage showed stability in membranes formed on silicon supports and a reduced stability when formed onto lipid monolayer covered supports. Atomic force microscopy studies on preparations in liquid showed bilayer structures but also attached, partly fused liposomes and membrane particles. In air, the surface was smoother and contained less of liposomes and more of stacked lipid layers. Preparations labelled with streptavidin conjugated to colloidal gold and imaged in air showed the proteins individually distributed, with no protein-rich patches or protein aggregates.

Biosensing Techniques↗

PubMed2000

Cataract surgery and effectiveness. 1. Variation in costs between different providers of cataract surgery.

PURPOSE: To describe and analyse the cost of cataract surgery in four community-run eye clinics in Sweden and also to analyse differences in cost between these clinics. METHODS: The average cost of a cataract surgery episode was calculated including one pre-operative visit, the surgery itself and the post-operative visits. Included in the analysis were the costs of disposables, personnel, rent, depreciation, general anaesthesia, bed days and education. Excluded were the costs of complications and overhead costs. RESULTS: The average cost for one cataract surgery episode was 5052/6915 SEK (1 Euro = 8.57 SEK) with a variation from 4436/6202 to 6130/8293 between the clinics. The lower sum represents a minimum cost of personnel, the higher sum a maximum cost. CONCLUSION: A large variation in costs of cataract surgery was found in four providers of cataract surgery. Nearly all clinics studied had one or more areas with much higher costs than average.

Cataract Extraction↗

PubMed2000

The cost of cataract patients awaiting surgery.

PURPOSE: To describe the cost for society services caused by the patients awaiting surgery for one year in Gothenburg, 1997. METHODS: From a waiting list of 1458 patients awaiting cataract surgery 250 randomly selected patients were interviewed. The structured questions focused on community services, such as home help, subsidised travel by taxi, medical treatment at home, visual aids, hospital stay and medical consultation, caused by the cataract symptoms. RESULTS: The total cost for the community for the 1458 patients awaiting surgery was an estimated SEK 5,200,000. Hospital stay and home help were the largest parts of this community expense. CONCLUSION: The direct costs for society for one year caused by 1458 patients awaiting cataract surgery with a mean waiting time of 9.8 months was approximately the same as operating 800 patients (eyes).

Cataract↗

PubMed1999

Gender and cataract surgery in Sweden 1992-1997. A retrospective observational study based on the Swedish National Cataract Register.

PURPOSE: To study the gender difference in total utilisation of cataract surgery in Sweden during the years 1992-1997. METHODS: The study is based on data from the National Swedish Cataract Register which covers about 95% of all cataract operations performed in Sweden during the study period. RESULTS: Utilisation of cataract surgery in Sweden was significantly higher in females than in males for all age groups between 50 and 89 years of age during the period 1992-1997. This gender difference was more pronounced for second eye surgery than first eye surgery in most age groups. The gender difference varied also depending on the pre-operative visual acuity. CONCLUSION: The cataract surgery rate was significantly higher for females compared to males during the study period. Three hypotheses to explain the gender difference are discussed.

Aged↗

PubMed1999

Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome.

AIM: To analyse possible predictors of the self assessed functional outcome of a cataract extraction. METHODS: The patients' self assessed visual function was studied by use of a questionnaire, the "Catquest", before and 6 months after surgery. All patients (n=1933, mean age 75.5 years, 66.8% women) who were undergoing cataract surgery in March 1995, in 35 different departments of ophthalmology participating in the National Swedish Cataract Register, were included in the study. A routine ophthalmic examination was performed before and after surgery. The following preoperative variables were studied with regard to a possible relation to the outcome: age, sex, ocular comorbidity, best corrected preoperative vision (better eye), first or second eye surgery, other diseases with a need for long term medication, need for home help, need for subsidised travel by taxi. RESULTS: Ocular comorbidity was strongly related to a "no benefit" outcome after surgery (p= 0.005). Second eye surgery and young age was related to a "very good benefit" outcome after surgery (p=0.0001 and p<0.0001 respectively). CONCLUSIONS: Patients with an ocular comorbidity in the eye undergoing a cataract extraction were characterised by a significantly higher frequency of deteriorated self assessed visual function after surgery than patients with no ocular comorbidity. The highest degree of improvement was most frequently found in younger patients undergoing second eye surgery.

Adult↗