Biomedical subjects

Martin Gellerstedt

Publications and source records attributed to Martin Gellerstedt.

6 recordsLinked to original sources

PubMed2007

Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery.

STUDY DESIGN: A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES: To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA: Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS: The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS: Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS: Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results.

Adult↗

PubMed2006

Relationships between lower urinary tract symptoms, the bother they induce and erectile dysfunction.

OBJECTIVE: To study the relationships between lower urinary tract symptoms (LUTS), LUTS-induced bother, age and erectile dysfunction. MATERIAL AND METHODS: A survey consisting of two questionnaires, the International Prostate Symptom Score (IPSS) (reflecting LUTS) and the International Index of Erectile Function (IIEF)-5 (reflecting erectile function), together with instructions on how to perform timed micturition, was sent to 2000 randomly selected men (age range 60-70 years) living in the five counties surrounding our hospital. The IPSS questionnaire included a question concerning the degree of bother induced by LUTS. RESULTS: The survey was answered by 1096 men; after the exclusion of incomplete answers, 924 surveys were evaluated. Of these 924 men, 725 (78%) were sexually active and included in the analyses. The prevalence of moderate-to-severe LUTS (IPSS>or=8) was 45%. The prevalence of erectile dysfunction (ED), defined as an IIEF-5 score of <or=20, was 44%. IPSS correlated significantly with timed micturition, but not with age. IPSS was also, as expected, strongly correlated with LUTS-induced bother (correlation coefficient [c.c.] 0.76). The IIEF-5 score was correlated with timed micturition and age. There was a significant correlation between the IIEF-5 score and IPSS (c.c. -0.29; p<0.001). The IIEF-5 score was also correlated with LUTS-induced bother (c.c. -0.30; p<0.001). In a multivariate analysis, the presence of ED (IIEF-5 score<or=20) was significantly correlated with IPSS, LUTS-induced bother and age, but not with timed micturition. Men who were more severely bothered by LUTS more often had ED than those who were less bothered by them. CONCLUSIONS: LUTS and the bother it induces were independently significantly correlated with ED, as reflected by the IIEF-5 score. The relationships were, however, rather weak and we recommend further studies, preferably of a longitudinal and/or qualitative character, to gain a more profound understanding of the interaction, probably multifactorial, between LUTS, the bother it induces and ED. Such studies are necessary not only in order to better understand the possible causality but also to evaluate whether the relationships are of any practical value regarding the management of individual patients.

Aged↗

PubMed2006

Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?

OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

Advanced Cardiac Life Support↗

PubMed2006

Accommodation and the relationship to subjective symptoms with near work for young school children.

The aim of this work was to study the relation between subjective symptoms at near and ocular accommodation in terms of the amplitude of accommodation and the relative accommodation. A secondary aim was to discuss the diagnosis of accommodative insufficiency. The chosen cohort was examined on two occasions with 1.8 years in between. The first examination included 72 children, 43 boys (mean age 8.1 years, ranging from 5.8 to 9.8) and 29 girls (mean age 8.3 years, ranging from 6.2 to 10.0). The second examination included 59 of these children, 34 boys (mean age 9.9 years, ranging from 7.8 to 11.7) and 25 girls (mean age 10.1 ranging from 8.0 to 11.8). Subjective symptoms at near work (headache, asthenopia, floating text, facility problems) were recorded and the amplitude and the relative accommodation, both positive and negative, were measured. The result from the questionnaire showed that at the first examination more than one-third of the children (34.7%) reported at least one subjective symptom when doing near work and 42.4% at the second examination. No symptoms were found among children younger than 7.5 years, but for children between 7.5 and 10 years old at the first examination, the prevalence of at least one symptom was 47.2%. At the second examination, symptoms were reported also for the youngest children, i.e. from the age of 8 years. The discrimination ability for the amplitude of accommodation, both monocular and binocular, was significant. In the first examination the difference between the mean for the two groups (i.e. with and without at least one symptom) was around 2.00 D monocular and 3.00 D binocular. Corresponding figures from the second examination was a difference between the mean for the two groups of around 3.50 D monocular and nearly 4.00 D binocular. We suggest that accommodation measurements should be performed more routinely and regularly, maybe as screening, especially in children over 8 years of age.

Accommodation, Ocular↗

PubMed2006

Partitioning reference values of several Gaussian subpopulations with unequal prevalence--a procedure with computer program support.

BACKGROUND: To be able to interpret laboratory values, it is essential to develop population-based reference intervals. A crucial consideration is whether a reference interval should be divided into subpopulations or not, so-called partitioning. There are established methods for deciding whether partitioning should be done or not. However, these methods are only applicable when partitioning into two subpopulations is considered. The primary aim of this study was to suggest a procedure that was also valid for several subpopulations. The method assumes that these subpopulations are Gaussian. Furthermore, a secondary aim was to provide a tailor-made computer program to support calculations. METHODS: The fundamental idea is to partition reference intervals if the proportions of the distributions of the subpopulations outside the combined reference limit deviate from the nominal value of 0.025. This is made possible by finding the combined reference interval using an equation solver algorithm. RESULTS: It was found that an equation solver algorithm could easily identify the combined reference interval when combining two or more subpopulations, even if these subpopulations had unequal prevalences. It was also found that this could be done even if the ratio between samples does not reflect the ratio between prevalences. Using this algorithm, it was possible to study whether the proportion outside the combined reference limits in any of several subpopulations deviated from the nominal 0.025 by such a magnitude that partitioning was recommended. When similar figures to those found in earlier studies with other methods were tested, the procedure showed consistent results with these methods. The procedure was also found to be applicable when several subpopulations were considered. As a practical result of the study, a tailor-made computer program was developed and is now provided over the Internet. CONCLUSIONS: The suggested procedure could serve as an alternative or complement to existing methods. The procedure provides calculations of the combined reference interval, even if sample fractions do not reflect prevalence fractions. The important advantage with the suggested procedure is the generalisation to the situation when several Gaussian subpopulations, possibly with unequal prevalences, are considered. Finally, since a tailor-made computer program is provided, the procedure is simple to use.

Algorithms↗

PubMed2004

The amplitude of accommodation in 6-10-year-old children - not as good as expected!

The aim of this study was to measure the amplitude of accommodation for junior level school children and to compare it with age-expected values. A junior level school in Göteborg, Sweden, was randomly chosen and the amplitude of accommodation among 76 children aged 6-10 years was examined using Donders' push-up method. The results showed lower amplitude than expected in a large group of children. Results also showed lower amplitude than previously reported for this age group, especially under monocular conditions, which revealed an average dioptric difference from the expected value of -3.60 dioptres (D) right eye (mean 12.40 D, median 12.00 D, S.D. 3.7 D) and -3.50 D left eye (mean 12.50 D, median 12.70 D, S.D. 3.8 D) (p < 0.001 for both eyes). Consequently, we conclude that it cannot be assumed that the amplitude of accommodation is in the expected amplitude range for all children of these ages.

Accommodation, Ocular↗