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Biomedical subjects

M Lundström

Publications and source records attributed to M Lundström.

At least 37 records · Page 2Linked to original sources
PubMed1999

Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures.

The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.

Aged↗
PubMed1998

Catquest questionnaire for use in cataract surgery care: assessment of surgical outcomes.

PURPOSE: To demonstrate the outcome for patients after cataract extraction using the Catquest cataract questionnaire and discuss the models validity in assessing outcome. SETTING: Thirty-five Swedish departments of ophthalmology. METHODS: Patients having cataract extraction performed by surgeons from 35 Swedish departments of opthalmology participated in the study. The questionnaire was given to 2970 consecutive patients having surgery during March 1995 at the participating surgical units. The questionnaire was sent by mail to patients and completed on a voluntary basis. It focuses on visual disabilities in daily life, activity level, cataract symptoms, and degree of independence. The results form the questionnaire are interpreted using a benefit matrix that credits not only a decrease in visual disabilities and cataract symptoms but also an improvement in or maintenance of a preoperative activity level. RESULTS: Complete surgical outcome data and completed preoperative and postoperative questionnaires were available in 1933 cases (65.1%). Benefit from surgery according to the model was achieved by 90.9% of the patients. Patients having their second cataract extraction had the highest frequency of the greatest benefit form surgery. There was good agreement between the different levels of benefit from surgery according to the model and the patient's global rating of his or her vision or achieved visual acuity after surgery, respectively. Patients with missing data (did not return postoperative questionnaire or had missing surgical result variables) were older and had a higher frequency of other diseases and handicaps. CONCLUSION: The Catquest cataract questionnaire allowed the outcome of cataract surgery to be graded by different levels of benefit. There seemed to be good agreement between this model of assessment and the patient's global rating of his or her vision. Missing data may be a problem when a postal questionnaire is used.

Activities of Daily Living↗
PubMed1998

Assessment of the maximum waiting time guarantee for cataract surgery. The case of a Swedish policy.

Cataract is the most common reason for visual problems in old age. The introduction of intraocular lens (IOL) implantation revolutionized cataract surgery. Since the IOL technique was established in Sweden in the early 1980s, the demand for surgery has been increasing, leading to lengthy waiting lists. To shorten some of the most troublesome waiting lists, national and local governments (county councils) in Sweden introduced a maximum waiting time guarantee in 1992. The assessment of the guarantee made in this article shows that ophthalmic surgery units vary in their adoption of the guarantee, leading to different levels of goal achievement in waiting times for their patients. The less successful units could be divided into two groups: one where the units have a low operation rate, and one where the units chose not to follow the recommendations in priority setting made in the guarantee.

Aged↗
PubMed1998

Are weaning foods causing impaired iron and zinc status in 1-year-old Swedish infants? A cohort study.

We analysed whether 12-month-old Swedish infants who have been fed iron-fortified and relatively zinc-rich foods, according to current recommendations, have adequate iron and zinc status. A cohort of 76 healthy, full term Swedish infants was followed regarding feeding habits and growth from birth to 12 months of age, when haemoglobin, iron and zinc status were evaluated. Twenty-six percent of the infants had low (<12 microg/l) s-ferritin values, indicative of iron depletion, and 36% of the infants had low s-zinc concentrations (<10.7 micromol/l). Only two infants had both low haemoglobin and low s-ferritin values. s-Zinc and s-iron were positively correlated, and s-zinc and s-transferrin receptor values were negatively correlated. Lower birthweight was associated with lower s-ferritin levels at 12 months in boys, and with increased s-transferrin receptor values in girls. Feeding habits during infancy were relatively homogeneous, dominated by breastfeeding, iron-fortified milk- and cereal-based follow-on formula. No clear association between feeding pattern and iron and zinc status was found. The results indicate that in a group of healthy, well growing 12-month-old Swedish infants one-quarter is iron-depleted, although iron deficiency anaemia is rare, and one-third may be zinc-depleted. The high cereal intake of Swedish infants from 6 months of age may have limited the bioavailability of both iron and zinc from the diet.

Age Distribution↗
PubMed1998

Criminal multilation of the human body in Sweden--a thirty-year medico-legal and forensic psychiatric study.

During the 30-year period 1961-1990, a total of 22 deaths with criminal multilation/dismemberment of the human body were registered in Sweden. The multilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Multilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic multilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the "serial killing" type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

Adolescent↗
PubMed1997

Catquest questionnaire for use in cataract surgery care: description, validity, and reliability.

PURPOSE: To describe and evaluate the Catquest self-assessment questionnaire for cataract patients. SETTING: Thirty-five Swedish departments of ophthalmology. METHODS: The Catquest is designed to be used by cataract surgeons for continuous quality control regarding appropriateness and outcome of surgery. It is administered before and after cataract surgery. The questionnaire focuses on visual disabilities in daily life, activity level, cataract symptoms, and degree of independence. The results are interpreted using a benefit matrix that credits not only a decrease in visual disabilities and cataract symptoms but also an improvement or a maintenance of a preoperative activity level. The questionnaire was used by consecutive patients having surgery during March 1995 at the participating surgical units. RESULTS: A full range of responses was given to all questions. A strong relationship was found between patients' responses to questions about visual disabilities in daily life and their general opinion about vision (P < .001). The answers showed a high stability when test-retest reliability was evaluated and a high internal consistency when different questions about visual disabilities were compared (P < .001). The answers from cataract patients before surgery were significantly different from those of a control group that did not have cataract (P < .0001). CONCLUSION: The Catquest had high validity and reliability when used as a disease-specific instrument testing visual disabilities in patients having cataract extraction.

Aged↗
PubMed1997

Quality of life among patients with glaucoma in Sweden.

PURPOSE: To assess the health-related quality of life (HRQOL) in an unselected sample of patients with glaucoma. METHODS: The HRQOL was studied in a cross-sectional survey in 270 patients from two departments of ophthalmology in different parts of Sweden by using the Swedish Health-Related Quality of Life Survey, a generic HRQOL-instrument adapted from the Medical Outcomes Study. RESULTS: Compared to a random Standard Population Sample, the glaucoma patients showed lower mean score only in the scale of 'Pain' (p < 0.05, effect size 0.17), but higher mean score in 'Sexual functioning' (p < 0.01, effect size 0.35). Significant factors correlated to a lower score on HRQOL-scales were decreased visual acuity and visual field, and comorbidity of cardiovascular and non-vascular systemic diseases. Regarding the topical medications, beta-blockers with or without miotic agents had no negative impact on the HRQOL. CONCLUSION: Our findings indicate that health-related quality of life in glaucoma patients in general is good, especially when vision is intact, and that topical beta-blockers do not have any negative influence.

Aged↗
PubMed1997

An outcome study of cataract surgery based on a national register.

PURPOSE: To test the viability of performing a national cataract outcome study with a national cataract register as a reference base. METHODS: Seven Swedish eye clinics participated. All patients operated during the month of January 1994 were included. The total number of patients was 605. RESULTS: This outcome study is based on few, but well defined parameters. On the basis of these measurements quality indicators are suggested that makes comparison between surgeons/clinics possible. CONCLUSION: Outcome studies are different from controlled clinical trials. They are less time consuming and designed to describe the outcome of surgery in daily practise. An outcome study of cataract surgery does not replace the careful monitoring of each patient at the clinical level, which is necessary for the development of new surgical technics and medical treatments. However, an outcome study can provide an overall quality description of cataract surgery in the daily practise of any given surgical unit.

Aged↗
PubMed1996

Effect of mast cell growth factor on clonogenic blast cell growth in acute myelogenous leukemia.

The effect of the mast cell growth factor (MGF), also known as stem cell factor, steel factor, and kit ligand, alone or in combination with other GFs on clonogenic blast cell growth in 23 patients with acute myeloblastic leukemia (AML) was investigated. MGF alone enhanced colony formation by about 35%, being clearly stimulatory (> 20% increase in colony numbers) in nine patients. The additive effect of MGF on colony growth was observed in combination with interleukin-3 (IL-3). Preincubation of the cells with MGF in suspension did not sensitize them to the effect of IL-3, granulocyte-macrophage colony-stimulating factor (GM-CSF), G-CSF, or IL-4 in a clonogenic cell culture assay. Although almost all the blast cell samples expressed the c-kit the receptor for MGF, at the mRNA and/or the protein level, the cells did not necessarily respond to exogenous MGF. On the other hand, blast cells were able to respond to exogenous MGF even when the cells themselves expressed MGF. Neither the expression of MGF nor the response of blast cells to exogenous MGF was related to the capability of the cells to form colonies spontaneously. In conclusion, MGF alone, but especially combined with IL-3, was a potent growth factor for clonogenic blast cells in AML. Autocrine production of MGF by AML blast cells analyzed at the mRNA level was not related to autonomous growth of the cells.

Adult↗
PubMed1996

Assessment of waiting time and priority setting by means of a national register.

To increase access to care for cataract patients in Sweden, it was decided, starting in 1992, that all cataract patients listed for surgery and with priority should have their cataract extraction performed within three months. To evaluate the effect of this waiting time guarantee, a National Cataract Register (NCR) was initiated in late 1991. In 1992, 81% of all cataract extractions performed in Sweden were reported to the NCR; in 1993 this figure was 92%. Reasons for this high participation ratio are discussed. In 1993, 74.4% (range between different clinics, 40-99%) of the patients with priority had their operation performed within three months. Great variation in visual acuity and age was found in patients with priority among the different surgical units.

Cataract Extraction↗
PubMed1995

Pharmacokinetics of HI-6 and atropine in anaesthetized pigs after administration by a new autoinjector.

A newly developed autoinjector (Astra Tech, Sweden) containing 500 mg HI-6 and 2 mg atropine sulphate was tested in anaesthetized normal pigs. The pharmacokinetics and pharmacodynamics of the drugs after administration by the autoinjector were compared with those after conventional needle and syringe delivery intramuscularly and intravenously. Cardiopulmonary parameters were monitored and serum concentrations of oxime, atropine, and acetylcholinesterase were determined in blood samples taken at intervals over a 6 h period postinjection. After injection in anaesthetized pigs, both HI-6 and atropine were absorbed rapidly and completely from the injection site. Therapeutic serum concentrations of HI-6, arbitrarily taken as 4 micrograms mL-1, were reached within 1 min of intravenous and autoinjector administration, and within 5 min of intramuscular injection. The concentrations remained above this level for 3-4 h. There were no significant changes in acetylcholinesterase activity, mean arterial blood pressure, or respiration frequency after injection of HI-6 and atropine sulphate. The heart rates increased significantly after administration of the two drugs (cardioacceleration defined as > or = 5% increase in heart rate), regardless of the technique employed. Our results show that HI-6 and atropine sulphate can be given intramuscularly by the new autoinjector with the same effectiveness and speed as when given intravenously. Irrespective of the injection technique, no overt signs of toxicity were observed at the drug concentrations used.

Acetylcholinesterase↗
PubMed1995

Treatment of organophosphate poisoning in pigs: antidote administration by a new binary autoinjector.

The therapeutic effectiveness of a new binary autoinjector containing 500 mg HI-6 and 2 mg atropine sulphate was tested in anesthetized pigs poisoned by a lethal dose of soman i.v. (9 micrograms/kg per 20 min). Pharmacokinetics and pharmacodynamics of HI-6 were studied concomitantly on administration of HI-6 alone, together with atropine sulphate, or together with atropine sulphate during soman intoxication. Cardiopulmonary parameters were monitored and serum concentrations of oxime and acetylcholinesterase (AChE) were measured in blood samples taken at intervals over a 6-h period postinjection. Five minutes after the start of soman infusion, mean AChE activity was decreased to 27 +/- 4.3% of baseline and signs of poisoning appeared. The antidotes, HI-6 and atropine sulphate, were then administered i.m. One minute after this injection there was a transient significant increase in AChE activity of 76 +/- 8.2% of baseline (p < 0.01). It then again decreased and remained suppressed throughout the experiment. Mean respiratory rate was significantly decreased (p < 0.01) to 20 +/- 3.2% of baseline after 20 min of soman infusion and remained low during the rest of the experiment. The poisoning signs were counteracted 15-20 min after antidote therapy and all pigs survived soman intoxication without ventilatory assistance. Administration of either atropine or atropine and soman had no significant effect on the pharmacokinetics of HI-6 in anesthetized pigs.

Animals↗
PubMed1995

A national Cataract Register. I. Description and epidemiology.

In 1992 a Swedish National Cataract Register was instituted. More than 90% of all cataract surgeries are performed at community run eye clinics. All community run eye clinics in the country participated and 89% of all cataracts performed are included in this register. In total 31,679 eyes were entered. All the pertinent preoperative information on these patients can be found in the register. As indicated in other studies two-thirds of the surgeries were performed on women and one-third of the surgeries was performed on second eyes. The number of surgeries equals 4.5 per 1000 inhabitants and this figure has steadily increased since 1980.

Adolescent↗
PubMed1994

Vision related daily life problems in patients waiting for a cataract extraction.

Problems in daily life activities caused by bad vision were studied in 150 patients with cataract before and 6 months after a cataract extraction. A relation was found between binocular visual acuity before surgery and the number of problems experienced (p < 0.001). After cataract extraction a reduction in problems was closely associated with an increase in visual acuity (p < 0.001) and also, in the patients' opinion, a better life situation (p < 0.001). Six questions to be answered when considering surgery are given.

Activities of Daily Living↗
PubMed1988

Incorporation into nucleic acids of the antiherpes guanosine analog buciclovir, and effects on DNA and protein synthesis.

Using cells expressing herpes simplex virus (HSV) thymidine kinase, we investigated the metabolism of the acyclic antiherpes guanosine analog buciclovir, in relation to the effects of the drug on viral DNA and protein synthesis. In these cells the predominant metabolite of buciclovir was its triphosphate, as in the HSV-1 infected Vero cells investigated in parallel. Further metabolism of buciclovir led to incorporation into RNA and DNA. Buciclovir inhibited DNA synthesis, not RNA synthesis, and prevented an increase in the size of newly synthesized DNA. To study the relative effects of BCV on cellular and viral DNA synthesis, human TK-cells transformed to a TK+ phenotype with HSV-2 DNA, were infected with HSV-1. In these HSV-1 infected cells buciclovir-triphosphate caused a preferential inhibition of viral DNA synthesis. Despite incorporation of buciclovir into RNA, and the presence of buciclovir-triphosphate from the time of infection onwards, no effect was observed on the synthesis of the beta proteins ICP-6 and ICP-8. Presumably as a consequence of inhibition of viral DNA synthesis, the synthesis of a beta gamma protein (gD) and a gamma protein (gC) were inhibited, and synthesis of the beta proteins (ICP-6 and ICP-8) was not shut-off. Glycosylation of gC that was still synthesized, was not inhibited. Thus, the biological effects of buciclovir can be explained by its inhibition of DNA synthesis.

Acyclovir↗